MEDICARE: 7TH AVENUE CHEMIST 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	028134	NY

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
2	3352767	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1366506867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	7TH AVENUE CHEMIST INC

Provider Business Mailing Address
First Line	:	679 60TH ST UNIT B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4108
Country	:	US
Telephone Number	:	718-439-0998
Fax Number	:

Provider Business Practice Location Address
First Line	:	679 60TH ST UNIT B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4108
Country	:	US
Telephone Number	:	718-439-0998
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOK DOON JOHN AU
Credential	:
Telephone Number	:	212-965-9688

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	12/08/2020

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