MEDICARE: MILE SQUARE PHARMACY 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	3336C0003X	Community/Retail Pharmacy	013593	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	013593	OTHER	NY	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003968652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILE SQUARE PHARMACY INC

Provider Business Mailing Address
First Line	:	855 MIDLAND AVE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10704-1024
Country	:	US
Telephone Number	:	914-965-1878
Fax Number	:	914-963-4022

Provider Business Practice Location Address
First Line	:	855 MIDLAND AVE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10704-1024
Country	:	US
Telephone Number	:	914-965-1878
Fax Number	:	914-963-4022

Authorized Official
Title or Position	:	PRESIDENT SUPERVISING PHARMACIST
Name	:	MR. ROBERT LEPORE
Credential	:
Telephone Number	:	914-965-1878

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	03/07/2023

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Directions to “MILE SQUARE PHARMACY INC ” Practice Location

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