MEDICARE: K.I.S. 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	183500000X	Pharmacist

General Provider Information

NPI Number	:	1194018911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K.I.S. PHARMACY, INC.

Provider Business Mailing Address
First Line	:	3050 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1204
Country	:	US
Telephone Number	:	347-497-7333
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1204
Country	:	US
Telephone Number	:	347-497-7333
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	MRS. KORINA SIGAL
Credential	:	PHARM.D.
Telephone Number	:	917-975-5125

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	05/26/2011

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