MEDICARE: RELIABLE 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1710461199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIABLE PHARMACY INC

Provider Business Mailing Address
First Line	:	10710A 71ST RD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4719
Country	:	US
Telephone Number	:	718-880-1514
Fax Number	:	646-397-3851

Provider Business Practice Location Address
First Line	:	10710A 71ST RD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4719
Country	:	US
Telephone Number	:	718-880-1514
Fax Number	:	646-397-3851

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAM SHALOM KIKOV
Credential	:
Telephone Number	:	718-880-1514

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	02/14/2019

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