MEDICARE: DRUGLAND PHARMACY CORP.

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

General Provider Information

NPI Number	:	1528446168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRUGLAND PHARMACY CORP.

Provider Business Mailing Address
First Line	:	5806 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4832
Country	:	US
Telephone Number	:	718-972-1056
Fax Number	:	718-972-1063

Provider Business Practice Location Address
First Line	:	5806 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4832
Country	:	US
Telephone Number	:	718-972-1056
Fax Number	:	718-972-1063

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES LONG
Credential	:
Telephone Number	:	718-972-1056

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	10/12/2016

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