MEDICARE: KENSINGTON 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	029935	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3364801	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1083937098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENSINGTON PHARMACY INC

Provider Business Mailing Address
First Line	:	309 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3105
Country	:	US
Telephone Number	:	347-533-6619
Fax Number	:	347-533-6618

Provider Business Practice Location Address
First Line	:	309 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3105
Country	:	US
Telephone Number	:	347-533-6619
Fax Number	:	347-533-6618

Authorized Official
Title or Position	:	S.P.
Name	:	RUBEN SAFIR
Credential	:
Telephone Number	:	347-533-6619

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	03/12/2010

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