MEDICARE: FENIX PHARMACEUTICAL SERVICES

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	022437	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164407243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FENIX PHARMACEUTICAL SERVICES

Provider Business Mailing Address
First Line	:	341 KNICKERBOCKER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3740
Country	:	US
Telephone Number	:	718-366-6545
Fax Number	:	718-418-3416

Provider Business Practice Location Address
First Line	:	341 KNICKERBOCKER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3740
Country	:	US
Telephone Number	:	718-366-6545
Fax Number	:	718-418-3416

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	MR. LEONARD SPECTOR
Credential	:
Telephone Number	:	718-366-6545

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	12/02/2008

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