MEDICARE: KNICKERBOCKER CHEMISTS 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	332B00000X	Durable Medical Equipment & Medical Supplies	032750	NY
2	3336C0003X	Community/Retail Pharmacy	032750	NY

General Provider Information

NPI Number	:	1518369263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNICKERBOCKER CHEMISTS INC.

Provider Business Mailing Address
First Line	:	360 KNICKERBOCKER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-8053
Country	:	US
Telephone Number	:	718-483-9102
Fax Number	:	718-483-9104

Provider Business Practice Location Address
First Line	:	360 KNICKERBOCKER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-8053
Country	:	US
Telephone Number	:	718-483-9102
Fax Number	:	718-483-9104

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. SAL HALABI
Credential	:	PHARM.D
Telephone Number	:	718-483-9102

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	09/12/2018

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