MEDICARE: MEDINA 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	3336C0003X	Community/Retail Pharmacy	018486	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2145101	OTHER		PK

General Provider Information

NPI Number	:	1194864793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDINA PHARMACY INC

Provider Business Mailing Address
First Line	:	5721 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3876
Country	:	US
Telephone Number	:	718-439-3500
Fax Number	:	718-439-5207

Provider Business Practice Location Address
First Line	:	5721 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3876
Country	:	US
Telephone Number	:	718-439-3500
Fax Number	:	718-439-5207

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AURORA WONG
Credential	:
Telephone Number	:	718-439-3500

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	04/07/2014

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Directions to “MEDINA PHARMACY INC ” Practice Location

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