MEDICARE: A.Y. 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

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	:	1043291057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.Y. PHARMACY INC.

Provider Business Mailing Address
First Line	:	2070 BATH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4904
Country	:	US
Telephone Number	:	718-372-8795
Fax Number	:	718-372-9419

Provider Business Practice Location Address
First Line	:	2070 BATH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4904
Country	:	US
Telephone Number	:	718-372-8795
Fax Number	:	718-372-9419

Authorized Official
Title or Position	:	PRESIDENT/PHARMACIST
Name	:	MR. ARIK YERSHOV
Credential	:	RPH
Telephone Number	:	718-372-8795

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	02/26/2008

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