MEDICARE: MILLENNIUM 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	024581	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	2066875	OTHER		PK

General Provider Information

NPI Number	:	1023196532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM PHARMACY INC

Provider Business Mailing Address
First Line	:	3420 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-1716
Country	:	US
Telephone Number	:	718-348-5000
Fax Number	:	718-348-5005

Provider Business Practice Location Address
First Line	:	3420 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-1716
Country	:	US
Telephone Number	:	718-348-5000
Fax Number	:	718-348-5005

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MASHUKUR RAHMAN
Credential	:
Telephone Number	:	718-348-5000

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	02/11/2016

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