=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588697692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAMER PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 02/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6725 BAY PKWY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204-4735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-837-0600
-----------------------------------------------------
Fax | 718-837-0140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6725 BAY PKWY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204-4735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-837-0600
-----------------------------------------------------
Fax | 718-837-0140
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | ANATOLY VOSKOBOYNIK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-837-0600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 025119
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------