Healthcare Provider Details

I. General information

NPI: 1215387931
Provider Name (Legal Business Name): SKS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 LIVONIA AVE
BROOKLYN NY
11207-5308
US

IV. Provider business mailing address

611 LIVONIA AVE.
BROOKLYN NY
11207-9524
US

V. Phone/Fax

Practice location:
  • Phone: 718-385-6000
  • Fax: 718-385-6000
Mailing address:
  • Phone: 718-385-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number034594
License Number StateNY

VIII. Authorized Official

Name: SHAHARIA RAHMAN
Title or Position: MANAGER
Credential:
Phone: 718-385-6000