MEDICARE: BRITTANY 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	1835N1003X	Nutrition Support Pharmacist	025310	NY
2	1835P1200X	Pharmacotherapy Pharmacist	025310	NY
3	183500000X	Pharmacist	025310	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	025310	OTHER	NM	PHARMACY LICENSE NUMBER
2	3326231	OTHER	NY	NCPDP NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	J4T	OTHER	NY	ETIN NUMBER

General Provider Information

NPI Number	:	1114915774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRITTANY PHARMACY CORP.

Provider Business Mailing Address
First Line	:	395 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6004
Country	:	US
Telephone Number	:	718-339-3131
Fax Number	:	718-339-9232

Provider Business Practice Location Address
First Line	:	395 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6004
Country	:	US
Telephone Number	:	718-339-3131
Fax Number	:	718-339-9232

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	MRS. LUBA BALYASNY
Credential	:	RPH
Telephone Number	:	718-339-3131

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	03/07/2023

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Directions to “BRITTANY PHARMACY CORP. ” Practice Location

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