MEDICARE: SHIMONS PHARMACY 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	3336C0003X	Community/Retail Pharmacy	024761	NY

General Provider Information

NPI Number	:	1629147012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIMONS PHARMACY INC

Provider Business Mailing Address
First Line	:	115 LEE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-7904
Country	:	US
Telephone Number	:	718-384-0234
Fax Number	:	718-384-3910

Provider Business Practice Location Address
First Line	:	115 LEE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-7904
Country	:	US
Telephone Number	:	718-384-0234
Fax Number	:	718-384-3910

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERSEL KOHANTEB
Credential	:
Telephone Number	:	718-384-0234

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/09/2022

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