MEDICARE: THROOP 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	3336C0004X	Compounding Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy
4	3336L0003X	Long Term Care Pharmacy
5	3336C0003X	Community/Retail Pharmacy	035171	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2167584	OTHER		PK

General Provider Information

NPI Number	:	1396282141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THROOP PHARMACY INC

Provider Business Mailing Address
First Line	:	241 THROOP AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-6611
Country	:	US
Telephone Number	:	718-484-3361
Fax Number	:	718-484-3362

Provider Business Practice Location Address
First Line	:	241 THROOP AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-6611
Country	:	US
Telephone Number	:	718-484-3361
Fax Number	:	718-484-3362

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GENADY MAYZEL
Credential	:
Telephone Number	:	718-484-3361

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	04/05/2017

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