MEDICARE: GM 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	026552	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2061674	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891863692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GM PHARMACY INC

Provider Business Mailing Address
First Line	:	174 AVENUE O
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4918
Country	:	US
Telephone Number	:	718-256-7757
Fax Number	:	718-256-7747

Provider Business Practice Location Address
First Line	:	174 AVENUE O
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4918
Country	:	US
Telephone Number	:	718-256-7757
Fax Number	:	718-256-7747

Authorized Official
Title or Position	:	OWNER
Name	:	IOSIF TARTAKOVSKIY
Credential	:
Telephone Number	:	718-256-7757

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	10/28/2016

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Directions to “GM PHARMACY INC ” Practice Location

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