MEDICARE: MEACHAM PHARMACY

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	015262	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3353923	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1023113677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEACHAM PHARMACY

Provider Business Mailing Address
First Line	:	107 MEACHAM AVE
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-2630
Country	:	US
Telephone Number	:	516-354-2950
Fax Number	:	516-354-3375

Provider Business Practice Location Address
First Line	:	107 MEACHAM AVE
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-2630
Country	:	US
Telephone Number	:	516-354-2950
Fax Number	:	516-354-3375

Authorized Official
Title or Position	:	S P
Name	:	LAURA BENINCASA
Credential	:	R PH BS
Telephone Number	:	516-354-2950

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	09/19/2013

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Directions to “MEACHAM PHARMACY ” Practice Location

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