MEDICARE: AUSTRA LINE 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	183500000X	Pharmacist	027830	NY

General Provider Information

NPI Number	:	1437254844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTRA LINE PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 340250
Second Line	:	5916 GLENWOOD ROAD
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	718-531-6000
Fax Number	:	718-531-6004

Provider Business Practice Location Address
First Line	:	5916 GLENWOOD ROAD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	718-531-6000
Fax Number	:	718-531-6004

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHINEDU M AGBASIONWE
Credential	:
Telephone Number	:	718-531-6000

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/22/2020

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