MEDICARE: MICAELA 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	022656	NY
2	3336C0003X	Community/Retail Pharmacy	022656	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

General Provider Information

NPI Number	:	1215007331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICAELA INC .

Provider Business Mailing Address
First Line	:	2501 BROADWAY
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-3413
Country	:	US
Telephone Number	:	718-721-3650
Fax Number	:	718-721-1220

Provider Business Practice Location Address
First Line	:	2501 BROADWAY
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-3413
Country	:	US
Telephone Number	:	718-721-3650
Fax Number	:	718-721-1220

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ANASTASIA MASTROGIANNIS
Credential	:	ESQ.
Telephone Number	:	718-721-3650

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	09/11/2025

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Directions to “MICAELA INC . ” Practice Location

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