MEDICARE: HOSP PHARMA LLC

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	031770	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2139499	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346593779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSP PHARMA LLC

Provider Business Mailing Address
First Line	:	759 WASHINGTON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4504
Country	:	US
Telephone Number	:	718-638-3800
Fax Number	:	718-638-0239

Provider Business Practice Location Address
First Line	:	759 WASHINGTON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4504
Country	:	US
Telephone Number	:	718-638-3800
Fax Number	:	718-638-0239

Authorized Official
Title or Position	:	OWNER
Name	:	VIJAY VASIREDDY
Credential	:
Telephone Number	:	718-638-3800

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	09/21/2015

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Directions to “HOSP PHARMA LLC ” Practice Location

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