MEDICARE: CODUMEL PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	013969	NY
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3303598	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1427031749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CODUMEL PHARMACY INC

Provider Business Mailing Address
First Line	:	114 BEVERLEY RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 BEVERLEY RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3914
Country	:	US
Telephone Number	:	718-435-6161
Fax Number	:	718-871-2090

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD COHEN
Credential	:	RPH
Telephone Number	:	718-435-6161

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	09/11/2025

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Directions to “CODUMEL PHARMACY INC ” Practice Location

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