MEDICARE: S&A DRUG STORE 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	034672	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2162154	OTHER		PK

General Provider Information

NPI Number	:	1861945396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S&A DRUG STORE INC

Provider Business Mailing Address
First Line	:	11 S 4TH AVE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-3104
Country	:	US
Telephone Number	:	914-668-9300
Fax Number	:	914-668-9311

Provider Business Practice Location Address
First Line	:	11 S 4TH AVE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-3104
Country	:	US
Telephone Number	:	914-668-9300
Fax Number	:	914-668-9311

Authorized Official
Title or Position	:	S.PHARMACIST
Name	:	PETER NGUYEN
Credential	:
Telephone Number	:	914-668-9300

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	08/02/2016

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Directions to “S&A DRUG STORE INC ” Practice Location

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