MEDICARE: SKYCARE RX 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

General Provider Information

NPI Number	:	1366048837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYCARE RX PHARMACY, INC.

Provider Business Mailing Address
First Line	:	221 BROAD ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2057
Country	:	US
Telephone Number	:	718-682-1533
Fax Number	:	718-382-1533

Provider Business Practice Location Address
First Line	:	221 BROAD ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2057
Country	:	US
Telephone Number	:	718-682-1311
Fax Number	:	718-682-7533

Authorized Official
Title or Position	:	OWNER
Name	:	RAMY MOHAMED ELFEKY
Credential	:
Telephone Number	:	646-764-0224

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	12/09/2020

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