MEDICARE: GEORGE KILADA PHARMD

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	183500000X	Pharmacist	063626	NY

General Provider Information

NPI Number	:	1093200388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE KILADA PHARMD

Provider Business Mailing Address
First Line	:	1340 63RD ST FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5319
Country	:	US
Telephone Number	:	646-625-9528
Fax Number	:

Provider Business Practice Location Address
First Line	:	5924 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4934
Country	:	US
Telephone Number	:	718-283-7233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	06/28/2018

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