MEDICARE: 86 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	F92378277
2	3336C0003X	Community/Retail Pharmacy	030327	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	:	1306157102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	86 PHARMACY INC.

Provider Business Mailing Address
First Line	:	2042 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3216
Country	:	US
Telephone Number	:	718-266-1268
Fax Number	:	718-266-1608

Provider Business Practice Location Address
First Line	:	2042 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3216
Country	:	US
Telephone Number	:	718-266-1268
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JENNY YU
Credential	:
Telephone Number	:	718-266-1268

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	01/19/2022

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