MEDICARE: IDEAL 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	018181	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	3380196	OTHER	NY	NCPDP

General Provider Information

NPI Number	:	1902947948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL PHARMACY INC.

Provider Business Mailing Address
First Line	:	5409 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3112
Country	:	US
Telephone Number	:	718-439-5900
Fax Number	:	718-439-3697

Provider Business Practice Location Address
First Line	:	5409 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3112
Country	:	US
Telephone Number	:	718-439-5900
Fax Number	:	718-439-3697

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ISMAT ULLAH CHAUDHARY
Credential	:	RPH
Telephone Number	:	917-892-3928

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	01/21/2020

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