MEDICARE: BROADWAY 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	025404	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	2061851	OTHER		PK

General Provider Information

NPI Number	:	1285676064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADWAY PHARMACY INC

Provider Business Mailing Address
First Line	:	1226 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-2906
Country	:	US
Telephone Number	:	718-443-1331
Fax Number	:	718-443-9438

Provider Business Practice Location Address
First Line	:	1226 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-2906
Country	:	US
Telephone Number	:	718-443-1331
Fax Number	:	718-443-9438

Authorized Official
Title or Position	:	MANAGER
Name	:	OLGA XANTHOPOULOS
Credential	:	DIRECTOR
Telephone Number	:	718-431-3311

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/22/2026

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