MEDICARE: TLA 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	3336C0004X	Compounding Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336M0003X	Managed Care Organization Pharmacy
4	333600000X	Pharmacy
5	3336C0003X	Community/Retail Pharmacy	030803	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	2132013	OTHER		PK

General Provider Information

NPI Number	:	1184917163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLA PHARMACY INC

Provider Business Mailing Address
First Line	:	395 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6004
Country	:	US
Telephone Number	:	718-339-3131
Fax Number	:	718-339-9232

Provider Business Practice Location Address
First Line	:	395 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6004
Country	:	US
Telephone Number	:	718-339-3131
Fax Number	:	718-339-9232

Authorized Official
Title or Position	:	OWNER
Name	:	TATYANA LEVIK
Credential	:
Telephone Number	:	917-951-7833

Provider Enumeration Date	:	05/24/2011
Last Update Date	:	04/01/2016

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Directions to “TLA PHARMACY INC ” Practice Location

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