MEDICARE: 731 PHARMACY CORP

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
2	3336C0003X	Community/Retail Pharmacy	021082	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
2	2067137	OTHER		PK

General Provider Information

NPI Number	:	1902847858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	731 PHARMACY CORP

Provider Business Mailing Address
First Line	:	691 COLUMBUS AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-7002
Country	:	US
Telephone Number	:	212-222-4400
Fax Number	:	212-222-4428

Provider Business Practice Location Address
First Line	:	691 COLUMBUS AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-7002
Country	:	US
Telephone Number	:	212-222-4400
Fax Number	:	212-222-4428

Authorized Official
Title or Position	:	OWNER/SUP RPH
Name	:	IVAN JOURDAIN
Credential	:
Telephone Number	:	212-222-4400

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	12/22/2016

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