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NPI Code Detail

MEDICARE: INTERSTATE PHARMACEUTICAL SERVICES

MEDICARE: INTERSTATE PHARMACEUTICAL SERVICES
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
1333600000XPharmacy
23336L0003XLong Term Care Pharmacy
33336C0003XCommunity/Retail Pharmacy019407NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12064547OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457497067
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERSTATE PHARMACEUTICAL SERVICES
Provider Business Mailing Address
First Line : 952 MCDONALD AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11218-5612
Country : US
Telephone Number : 718-435-3100
Fax Number : 718-435-1671
Provider Business Practice Location Address
First Line : 952 MCDONALD AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11218-5612
Country : US
Telephone Number : 718-435-3100
Fax Number : 718-435-1671
Authorized Official
Title or Position : SP
Name : ARTHUR KONIG
Credential :
Telephone Number : 718-435-3100
Provider Enumeration Date : 01/30/2007
Last Update Date : 09/22/2016

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Directions to “INTERSTATE PHARMACEUTICAL SERVICES ” Practice Location

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