MEDICARE: MEDEX 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

General Provider Information

NPI Number	:	1265672943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEX PHARMACY, INC

Provider Business Mailing Address
First Line	:	1166 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2912
Country	:	US
Telephone Number	:	718-859-6100
Fax Number	:	718-859-4294

Provider Business Practice Location Address
First Line	:	1166 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2912
Country	:	US
Telephone Number	:	718-859-6100
Fax Number	:	718-859-4294

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANGELICA GONZALEZ
Credential	:
Telephone Number	:	718-859-6100

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	08/31/2020

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Directions to “MEDEX PHARMACY, INC ” Practice Location

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