MEDICARE: NEW YORK AVE 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	018288	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

General Provider Information

NPI Number	:	1649393596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK AVE PHARMACY INC

Provider Business Mailing Address
First Line	:	3307 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:	718-856-8048
Fax Number	:	718-469-0424

Provider Business Practice Location Address
First Line	:	3307 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2711
Country	:	US
Telephone Number	:	718-856-8048
Fax Number	:	718-469-0424

Authorized Official
Title or Position	:	PHARMACIST /OWNER
Name	:	MR. ELWALEED M IBRAHIM
Credential	:
Telephone Number	:	718-856-8048

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	08/20/2015

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