MEDICARE: SRI 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	333600000X	Pharmacy	027440	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	:	1174510192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SRI PHARMACY, INC

Provider Business Mailing Address
First Line	:	2109 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3001
Country	:	US
Telephone Number	:	718-421-3600
Fax Number	:	718-434-4341

Provider Business Practice Location Address
First Line	:	2109 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3001
Country	:	US
Telephone Number	:	718-421-3600
Fax Number	:	718-434-4341

Authorized Official
Title or Position	:	PRESIDENT/ PHARMACIST
Name	:	WAQAR YUSSOUF
Credential	:	RPH
Telephone Number	:	718-421-3600

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	12/17/2008

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Directions to “SRI PHARMACY, INC ” Practice Location

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