MEDICARE: MEGACARE 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

General Provider Information

NPI Number	:	1184197030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEGACARE PHARMACY INC

Provider Business Mailing Address
First Line	:	315 E KINGSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4443
Country	:	US
Telephone Number	:	718-684-5088
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 E KINGSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4443
Country	:	US
Telephone Number	:	718-684-5088
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOISEY SULEYMANOV
Credential	:
Telephone Number	:	718-309-7272

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/03/2019

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