MEDICARE: MR. BRIAN KEITH FLYNN R.PH

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	183500000X	Pharmacist	037469	NY

General Provider Information

NPI Number	:	1013239920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN KEITH FLYNN R.PH

Provider Business Mailing Address
First Line	:	530 E 76TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3138
Country	:	US
Telephone Number	:	917-613-0504
Fax Number	:

Provider Business Practice Location Address
First Line	:	6404 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3729
Country	:	US
Telephone Number	:	718-236-5705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	02/18/2010

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