MEDICARE: MR. YURY KORNITSKY R.PH.

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	183500000X	Pharmacist	036403	NY

General Provider Information

NPI Number	:	1902137003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YURY KORNITSKY R.PH.

Provider Business Mailing Address
First Line	:	93 LONGWOOD DR
Second Line	:
City	:	ATHENS
State	:	NY
Zip	:	12015-2700
Country	:	US
Telephone Number	:	516-567-1667
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 BRIGHTON BEACH AVE
Second Line	:	ALL AMERICAN DRUGGIST, INC
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5558
Country	:	US
Telephone Number	:	718-891-2801
Fax Number	:	718-743-5804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2010
Last Update Date	:	01/29/2010

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