MEDICARE: THRIFTWAY FAR ROCKAWAY DRUG 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	3336C0003X	Community/Retail Pharmacy	011557	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3317220	OTHER	NY	NCPDP ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265537807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIFTWAY FAR ROCKAWAY DRUG CORP

Provider Business Mailing Address
First Line	:	2102 MOTT AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3302
Country	:	US
Telephone Number	:	718-327-2559
Fax Number	:	718-327-2491

Provider Business Practice Location Address
First Line	:	2102 MOTT AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3302
Country	:	US
Telephone Number	:	718-327-2559
Fax Number	:	718-327-2491

Authorized Official
Title or Position	:	PHARMACY DIRECTOR
Name	:	MR. MICHAEL EDWARD PEARLMAN
Credential	:	RPH
Telephone Number	:	212-737-5560

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/22/2020

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