MEDICARE: REVIVAL PHARMACY 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	28RO00134300	NJ
2	3336C0003X	Community/Retail Pharmacy	030991	NY
3	3336L0003X	Long Term Care Pharmacy	NP000806	PA
4	3336L0003X	Long Term Care Pharmacy	0003191	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2134031	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629347414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVAL PHARMACY LLC

Provider Business Mailing Address
First Line	:	5359B KINGS HIGHWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:	718-298-2222
Fax Number	:	718-298-3333

Provider Business Practice Location Address
First Line	:	5369 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6704
Country	:	US
Telephone Number	:	718-298-2222
Fax Number	:	718-298-3333

Authorized Official
Title or Position	:	COO
Name	:	MOSHE SOSKIN
Credential	:
Telephone Number	:	718-298-2222

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	03/28/2017

Similar Medicare Providers

1669578092 — METROPOLITAN HOME HEALTH PRODUCTS, INC.
Practice Location Address:

5359 KINGS HIGHWAY
BROOKLYN, NY
11203-6704

Practice Phone: 718-241-5102
Practice Fax: 718-241-0102

1922202316 — I & J SUPPLIES INC
Practice Location Address:

5377 KINGS HWY
BROOKLYN, NY
11203-6704

Practice Phone: 718-451-1010
Practice Fax:

1639492101 — MRS. KRISTINE ELIZABETH HACKETT RPH
Practice Location Address:

5369 KINGS HWY
BROOKLYN, NY
11203-6704

Practice Phone: 800-203-6282
Practice Fax:

1780962118 — CHRISTINE CHA PHARM.D.
Practice Location Address:

5359 KINGS HWY
BROOKLYN, NY
11203-6704

Practice Phone: 718-298-2222
Practice Fax:

1962746099 — MS. ASHLEY BETH MARINELLI PHARMD
Practice Location Address:

5369 KINGS HWY
BROOKLYN, NY
11203-6704

Practice Phone: 800-203-6282
Practice Fax:

1548630882 — JACQUELINE NGO
Practice Location Address:

5369 KINGS HIGHWAY
BROOKLYN, NY
11203-6704

Practice Phone: 718-475-1448
Practice Fax:

Directions to “REVIVAL PHARMACY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.