MEDICARE: ASM PHARMACY CORP

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
2	3336C0003X	Community/Retail Pharmacy	025510	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3328019	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104923044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASM PHARMACY CORP

Provider Business Mailing Address
First Line	:	1604 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6007
Country	:	US
Telephone Number	:	718-375-8900
Fax Number	:	718-375-0478

Provider Business Practice Location Address
First Line	:	1604 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6007
Country	:	US
Telephone Number	:	718-375-8900
Fax Number	:	718-375-0478

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	MIKHAIL ROYMTAN
Credential	:
Telephone Number	:	718-375-8900

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/25/2024

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Directions to “ASM PHARMACY CORP ” Practice Location

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