MEDICARE: FLATBUSH RX CORP

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
2	3336C0003X	Community/Retail Pharmacy	034265	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2157729	OTHER		PK

General Provider Information

NPI Number	:	1669839536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLATBUSH RX CORP

Provider Business Mailing Address
First Line	:	1855 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4840
Country	:	US
Telephone Number	:	718-677-4067
Fax Number	:	718-677-4209

Provider Business Practice Location Address
First Line	:	1855 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4840
Country	:	US
Telephone Number	:	718-677-4067
Fax Number	:	718-677-4209

Authorized Official
Title or Position	:	MANAGER
Name	:	GERGES AZEEZ
Credential	:
Telephone Number	:	718-677-4067

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	02/12/2024

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