MEDICARE: WILLIAMSBURG PHARMACY & SURGICAL SUPPLY 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	020346	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

General Provider Information

NPI Number	:	1033168950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSBURG PHARMACY & SURGICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	244 ROEBLING ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-5664
Country	:	US
Telephone Number	:	718-387-9772
Fax Number	:	718-387-8291

Provider Business Practice Location Address
First Line	:	244 ROEBLING ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-5664
Country	:	US
Telephone Number	:	718-387-9772
Fax Number	:	718-387-8291

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NICHOLAS J BELLOCHI
Credential	:	RPH
Telephone Number	:	718-387-9772

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	10/25/2007

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