MEDICARE: BROOKLYN HEIGHTS 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	032262	NY

General Provider Information

NPI Number	:	1306273792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN HEIGHTS PHARMACY CORP

Provider Business Mailing Address
First Line	:	160 ATLANTIC AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5604
Country	:	US
Telephone Number	:	718-643-6300
Fax Number	:	718-596-2700

Provider Business Practice Location Address
First Line	:	160 ATLANTIC AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5604
Country	:	US
Telephone Number	:	718-643-6300
Fax Number	:	718-596-2700

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MANSOUR MANSOUR
Credential	:	PHARMACIST
Telephone Number	:	718-643-6300

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	10/01/2013

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