MEDICARE: EVON PFARMACY

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	019252	NY

General Provider Information

NPI Number	:	1336265644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVON PFARMACY

Provider Business Mailing Address
First Line	:	160 ATLANTIC AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5604
Country	:	US
Telephone Number	:	718-797-5555
Fax Number	:	718-797-5555

Provider Business Practice Location Address
First Line	:	160 ATLANTIC AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5604
Country	:	US
Telephone Number	:	718-797-5555
Fax Number	:	718-797-5555

Authorized Official
Title or Position	:	HEAD PHARMACIST
Name	:	ALFRED H KHALIL
Credential	:	RPH
Telephone Number	:	718-797-5555

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/22/2020

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