MEDICARE: 18TH AVE PHARMACY 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	025629	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	2058804	OTHER		PK

General Provider Information

NPI Number	:	1285748251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	18TH AVE PHARMACY CORP

Provider Business Mailing Address
First Line	:	5411 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1928
Country	:	US
Telephone Number	:	718-331-3600
Fax Number	:	718-331-3099

Provider Business Practice Location Address
First Line	:	5411 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1928
Country	:	US
Telephone Number	:	718-331-3600
Fax Number	:	718-331-3099

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GRIGORY BEYLIK
Credential	:
Telephone Number	:	718-331-3600

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	11/25/2014

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Directions to “18TH AVE PHARMACY CORP ” Practice Location

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