MEDICARE: SAFETY DRUGS OF BENSONHURST 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	3336L0003X	Long Term Care Pharmacy
2	3336S0011X	Specialty Pharmacy	017831	NY
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	333600000X	Pharmacy
5	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	2061820	OTHER		PK

General Provider Information

NPI Number	:	1497842694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFETY DRUGS OF BENSONHURST INC

Provider Business Mailing Address
First Line	:	6404 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3729
Country	:	US
Telephone Number	:	718-236-5705
Fax Number	:	718-234-0961

Provider Business Practice Location Address
First Line	:	6404 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3729
Country	:	US
Telephone Number	:	718-236-5705
Fax Number	:	718-234-0961

Authorized Official
Title or Position	:	VP
Name	:	MR. MICHAEL PETRATOS
Credential	:	RPH
Telephone Number	:	718-236-5705

Provider Enumeration Date	:	10/07/2006
Last Update Date	:	11/15/2024

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