MEDICARE: K. DIAMOND 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	332B00000X	Durable Medical Equipment & Medical Supplies	020075	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	2065595	OTHER		PK

General Provider Information

NPI Number	:	1407963994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K. DIAMOND PHARMACY. INC

Provider Business Mailing Address
First Line	:	2064 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4314
Country	:	US
Telephone Number	:	718-377-4900
Fax Number	:	718-252-6050

Provider Business Practice Location Address
First Line	:	2064 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4314
Country	:	US
Telephone Number	:	718-377-4900
Fax Number	:	718-252-6050

Authorized Official
Title or Position	:	STORE MANAGER
Name	:	JASON A NAPOLITANO
Credential	:
Telephone Number	:	718-377-4900

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/05/2019

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