Healthcare Provider Details

I. General information

NPI: 1790018612
Provider Name (Legal Business Name): WYCKOFF PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GRAHAM AVE
BROOKLYN NY
11206-4108
US

IV. Provider business mailing address

5 GRAHAM AVE
BROOKLYN NY
11206-4108
US

V. Phone/Fax

Practice location:
  • Phone: 718-381-6200
  • Fax: 718-381-6201
Mailing address:
  • Phone: 718-381-6200
  • Fax: 718-381-6201

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 Number029785
License Number StateNY

VIII. Authorized Official

Name: MOHAMMAD RANA
Title or Position: SUPERVISING PHARMACIST
Credential: PHARMACY
Phone: 718-381-6200