MEDICARE: CITY DRUGS 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	025116	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

General Provider Information

NPI Number	:	1417947300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY DRUGS INC

Provider Business Mailing Address
First Line	:	422 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3108
Country	:	US
Telephone Number	:	718-686-2727
Fax Number	:	718-532-0855

Provider Business Practice Location Address
First Line	:	422 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3108
Country	:	US
Telephone Number	:	718-686-2727
Fax Number	:	718-532-0855

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAVEL SHINDER
Credential	:	RPH
Telephone Number	:	718-686-2727

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	02/27/2012

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