MEDICARE: LEVYS 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	028919	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	2070590	OTHER		PK

General Provider Information

NPI Number	:	1326205287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVYS PHARMACY INC

Provider Business Mailing Address
First Line	:	4021 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3564
Country	:	US
Telephone Number	:	718-633-4377
Fax Number	:	718-633-4378

Provider Business Practice Location Address
First Line	:	4021 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3564
Country	:	US
Telephone Number	:	718-633-4377
Fax Number	:	718-633-4378

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOSHE BADALOR
Credential	:
Telephone Number	:	718-633-4377

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	01/18/2017

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