MEDICARE: KASSEL PHARMACY LTD

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	016765	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	:	1790880557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KASSEL PHARMACY LTD

Provider Business Mailing Address
First Line	:	21811 JAMAICA AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-2124
Country	:	US
Telephone Number	:	718-464-0200
Fax Number	:	718-468-2493

Provider Business Practice Location Address
First Line	:	21811 JAMAICA AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-2124
Country	:	US
Telephone Number	:	718-464-0200
Fax Number	:	718-468-2493

Authorized Official
Title or Position	:	VP
Name	:	MR. PETER S KASSEL
Credential	:
Telephone Number	:	718-464-0200

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	02/04/2008

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Directions to “KASSEL PHARMACY LTD ” Practice Location

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