MEDICARE: 137 MOTT 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

General Provider Information

NPI Number	:	1053088567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	137 MOTT PHARMACY, INC.

Provider Business Mailing Address
First Line	:	137 MOTT ST FRNT A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4718
Country	:	US
Telephone Number	:	646-669-8220
Fax Number	:	646-669-8238

Provider Business Practice Location Address
First Line	:	137 MOTT ST FRNT A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4718
Country	:	US
Telephone Number	:	646-669-8220
Fax Number	:	646-669-8238

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YUEN CHAN
Credential	:	PHARMD.
Telephone Number	:	646-669-8220

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	08/25/2023

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