MEDICARE: EZMEDS PHARMA 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

General Provider Information

NPI Number	:	1659181311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZMEDS PHARMA INC

Provider Business Mailing Address
First Line	:	2110 RICHMOND RD STE G
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2572
Country	:	US
Telephone Number	:	718-351-7363
Fax Number	:	718-351-4972

Provider Business Practice Location Address
First Line	:	2110 RICHMOND RD STE G
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2572
Country	:	US
Telephone Number	:	718-351-7363
Fax Number	:	718-351-4972

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WASEEM AHMED SADIQ ALI
Credential	:
Telephone Number	:	718-351-7363

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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