MEDICARE: 272 DRUG CORP

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	183500000X	Pharmacist	017632	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	017632	OTHER	NY	PHARMACY REGISTRATION NUM
2	3376147	OTHER	NY	NABP NUMBER

General Provider Information

NPI Number	:	1366526584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	272 DRUG CORP

Provider Business Mailing Address
First Line	:	4623 CHURCH AV
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:	718-773-5547
Fax Number	:	718-773-5568

Provider Business Practice Location Address
First Line	:	4623 CHURCH AV
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:	718-773-4457
Fax Number	:	718-773-5568

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	MR. YACOOB NOOR
Credential	:	R.PH.
Telephone Number	:	718-773-5547

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	03/07/2023

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Directions to “272 DRUG CORP ” Practice Location

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