MEDICARE: EAST 16TH STREET 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	016318	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3325998	OTHER	NY	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033257498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST 16TH STREET PHARMACY, INC

Provider Business Mailing Address
First Line	:	1526 CORTELYOU RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-5608
Country	:	US
Telephone Number	:	718-282-7660
Fax Number	:	718-282-5152

Provider Business Practice Location Address
First Line	:	1526 CORTELYOU RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-5608
Country	:	US
Telephone Number	:	718-282-7660
Fax Number	:	718-282-5152

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AKTAR AHMED
Credential	:	PHARMD.
Telephone Number	:	718-282-7660

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	10/11/2023

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