MEDICARE: L.I.CITY 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	183500000X	Pharmacist	027844	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

General Provider Information

NPI Number	:	1295782712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L.I.CITY PHARMACY INC.

Provider Business Mailing Address
First Line	:	4469 21ST ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5112
Country	:	US
Telephone Number	:	718-729-6300
Fax Number	:	718-729-6392

Provider Business Practice Location Address
First Line	:	4469 21ST ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5112
Country	:	US
Telephone Number	:	718-729-6300
Fax Number	:	718-729-6392

Authorized Official
Title or Position	:	DIRECT OWNER/SUPERVISING PHARMACIST
Name	:	MISS WOO JUNG CHOI
Credential	:	RPH
Telephone Number	:	718-507-1343

Provider Enumeration Date	:	05/29/2006
Last Update Date	:	03/18/2009

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