MEDICARE: SBSC LLC

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
2	3336C0003X	Community/Retail Pharmacy	029288	NY

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	2119257	OTHER		PK

General Provider Information

NPI Number	:	1518102672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SBSC LLC

Provider Business Mailing Address
First Line	:	6910 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1305
Country	:	US
Telephone Number	:	718-680-2229
Fax Number	:	718-680-0228

Provider Business Practice Location Address
First Line	:	6910 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1305
Country	:	US
Telephone Number	:	718-680-2229
Fax Number	:	718-680-0228

Authorized Official
Title or Position	:	SP
Name	:	SUBAN CHUNG
Credential	:
Telephone Number	:	718-680-2229

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	07/19/2018

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Directions to “SBSC LLC ” Practice Location

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