MEDICARE: INTERNATIONAL HOLISTIC 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

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	:	1326437971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL HOLISTIC PHARMACY INC

Provider Business Mailing Address
First Line	:	3078 BRIGHTON 6TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	718-975-3733
Fax Number	:	718-975-3734

Provider Business Practice Location Address
First Line	:	3078 BRIGHTON 6TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	718-975-3733
Fax Number	:	718-975-3734

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY MICHAEL
Credential	:
Telephone Number	:	718-975-3733

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	07/05/2022

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