MEDICARE: SKYEMED,LLC

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	3336L0003X	Long Term Care Pharmacy	027765	NY

General Provider Information

NPI Number	:	1174692065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYEMED,LLC

Provider Business Mailing Address
First Line	:	1858 CORNAGA AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4304
Country	:	US
Telephone Number	:	718-502-9265
Fax Number	:	718-502-9265

Provider Business Practice Location Address
First Line	:	1858 CORNAGA AVENUE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691
Country	:	US
Telephone Number	:	718-502-9265
Fax Number	:

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	DR. DEIRDRE LAPHAUN SALAMAN
Credential	:	DPM
Telephone Number	:	718-502-9265

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/22/2020

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