MEDICARE: DONGNE 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	:	1174479216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONGNE PHARMACY INC

Provider Business Mailing Address
First Line	:	4329 209TH ST
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2761
Country	:	US
Telephone Number	:	917-444-1145
Fax Number	:	646-607-6699

Provider Business Practice Location Address
First Line	:	4329 209TH ST
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2761
Country	:	US
Telephone Number	:	917-444-1145
Fax Number	:	646-607-6699

Authorized Official
Title or Position	:	OWNER
Name	:	JAE LEE
Credential	:
Telephone Number	:	917-444-1145

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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