MEDICARE: FARMACON ENTERPRISES LTD

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	015627	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3362679	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265443824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACON ENTERPRISES LTD

Provider Business Mailing Address
First Line	:	8007 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4003
Country	:	US
Telephone Number	:	718-238-1090
Fax Number	:	718-748-9275

Provider Business Practice Location Address
First Line	:	8007 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4003
Country	:	US
Telephone Number	:	718-238-1090
Fax Number	:	718-748-9275

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	JOHN DEMETRIADES
Credential	:
Telephone Number	:	718-238-1090

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	10/19/2012

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Directions to “FARMACON ENTERPRISES LTD ” Practice Location

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