MEDICARE: BROTHER PHARMACY & SURGICALS 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	3336C0003X	Community/Retail Pharmacy	034248	NY

General Provider Information

NPI Number	:	1427414580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROTHER PHARMACY & SURGICALS INC

Provider Business Mailing Address
First Line	:	565 LENOX AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10037-1742
Country	:	US
Telephone Number	:	212-281-2345
Fax Number	:	212-281-6789

Provider Business Practice Location Address
First Line	:	565 LENOX AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10037-1742
Country	:	US
Telephone Number	:	212-281-2345
Fax Number	:	212-281-6789

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	MR. RAM NALAGORLA
Credential	:	MS RPH
Telephone Number	:	212-281-2345

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	09/19/2016

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