MEDICARE: COMMUNITY RECETA 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	026315	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2061105	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952384729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY RECETA INC

Provider Business Mailing Address
First Line	:	1713 UNIVERSITY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-6961
Country	:	US
Telephone Number	:	718-299-3044
Fax Number	:	718-299-4809

Provider Business Practice Location Address
First Line	:	1713 UNIVERSITY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-6961
Country	:	US
Telephone Number	:	718-299-3044
Fax Number	:	718-299-4809

Authorized Official
Title or Position	:	OWNER
Name	:	AKHTAR HUSSAIN
Credential	:
Telephone Number	:	718-299-3044

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	09/30/2014

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Directions to “COMMUNITY RECETA INC ” Practice Location

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