MEDICARE: FULTON 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	3336C0003X	Community/Retail Pharmacy	022727	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	:	1841200508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULTON PHARMACY INC

Provider Business Mailing Address
First Line	:	2818 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-2608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2818 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-2608
Country	:	US
Telephone Number	:	718-235-6394
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL LANDES
Credential	:
Telephone Number	:	718-235-6394

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	08/22/2020

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