MEDICARE: PHARM J 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
2	3336C0003X	Community/Retail Pharmacy	020772	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
2	2066812	OTHER		PK

General Provider Information

NPI Number	:	1184721029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARM J INC

Provider Business Mailing Address
First Line	:	1205 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3603
Country	:	US
Telephone Number	:	718-258-6686
Fax Number	:	718-258-2360

Provider Business Practice Location Address
First Line	:	1205 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3603
Country	:	US
Telephone Number	:	718-258-6686
Fax Number	:	718-258-2360

Authorized Official
Title or Position	:	OWNER, PRES
Name	:	LARRY BIRNBAUM
Credential	:	RPH
Telephone Number	:	718-258-6686

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/20/2016

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Directions to “PHARM J INC ” Practice Location

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