MEDICARE: MAGNAM 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	017016	NY

General Provider Information

NPI Number	:	1346395589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNAM PHARMACY INC

Provider Business Mailing Address
First Line	:	1236 FULTON STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1236 FULTON STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216
Country	:	US
Telephone Number	:	718-789-4645
Fax Number	:	718-789-4652

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KHURSHID ANWAR
Credential	:	RPH
Telephone Number	:	718-789-4645

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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