Healthcare Provider Details

I. General information

NPI: 1952589251
Provider Name (Legal Business Name): MEDICMASTERS PHARMACY & SURGICAL SUPPLIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16926 JAMAICA AVE
JAMAICA NY
11432-5286
US

IV. Provider business mailing address

16926 JAMAICA AVE
JAMAICA NY
11432-5286
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-4121
  • Fax: 718-206-4126
Mailing address:
  • Phone: 718-206-4121
  • Fax: 718-206-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number028734
License Number StateNY

VIII. Authorized Official

Name: MS. KAVEETA MAHARAJ
Title or Position: SUPERVISING PHARMACIST
Credential: RPH
Phone: 718-206-4121