MEDICARE: OCEANA EXPRESS 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	027336	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	3346865	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1376640292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEANA EXPRESS PHARMACY, INC

Provider Business Mailing Address
First Line	:	2009 AVE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3701
Country	:	US
Telephone Number	:	718-676-9666
Fax Number	:	718-232-0034

Provider Business Practice Location Address
First Line	:	2009 AVE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3701
Country	:	US
Telephone Number	:	718-676-9666
Fax Number	:	718-232-0034

Authorized Official
Title or Position	:	MENEGER
Name	:	MR. IGOR ELBERG
Credential	:
Telephone Number	:	718-676-9666

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/26/2013

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