MEDICARE: NY NORTHERN PHARMACY2 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	:	1669005971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY NORTHERN PHARMACY2 INC

Provider Business Mailing Address
First Line	:	19206 NORTHERN BLVD
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-2955
Country	:	US
Telephone Number	:	718-279-4888
Fax Number	:	718-279-8881

Provider Business Practice Location Address
First Line	:	19206 NORTHERN BLVD
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-2955
Country	:	US
Telephone Number	:	718-279-4888
Fax Number	:	718-279-8881

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DOSUNG ANDREW JUNG
Credential	:
Telephone Number	:	718-279-4888

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

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