MEDICARE: LONG BEACH PHARMACY LLC.

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	032843	NY

General Provider Information

NPI Number	:	1417361791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH PHARMACY LLC.

Provider Business Mailing Address
First Line	:	251 W PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3222
Country	:	US
Telephone Number	:	516-889-8877
Fax Number	:	516-889-8876

Provider Business Practice Location Address
First Line	:	251 W PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3222
Country	:	US
Telephone Number	:	516-889-8877
Fax Number	:	516-889-8876

Authorized Official
Title or Position	:	MEMBER
Name	:	SRIHARI VUTUKURI
Credential	:
Telephone Number	:	516-889-8877

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	01/06/2015

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