MEDICARE: 1622 VOORHIES AVE 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

General Provider Information

NPI Number	:	1083948129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1622 VOORHIES AVE PHARMACY INC

Provider Business Mailing Address
First Line	:	1622 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	347-462-9778
Fax Number	:	347-462-9781

Provider Business Practice Location Address
First Line	:	1622 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	347-462-9778
Fax Number	:	347-462-9781

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NATAN VINBAYTEL
Credential	:
Telephone Number	:	212-260-4878

Provider Enumeration Date	:	09/22/2009
Last Update Date	:	07/16/2010

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