MEDICARE: CHEMPLUS PHARMACY CORP

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	035700	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	2171129	OTHER		PK

General Provider Information

NPI Number	:	1205352002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEMPLUS PHARMACY CORP

Provider Business Mailing Address
First Line	:	648 SCHROEDERS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11239-2234
Country	:	US
Telephone Number	:	718-282-5504
Fax Number	:	718-282-5505

Provider Business Practice Location Address
First Line	:	2606 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4152
Country	:	US
Telephone Number	:	718-282-5504
Fax Number	:	718-282-5505

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	ABIMBOLA AYORINDE
Credential	:
Telephone Number	:	718-282-5504

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	07/19/2018

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Directions to “CHEMPLUS PHARMACY CORP ” Practice Location

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