MEDICARE: BLISS 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	3336C0003X	Community/Retail Pharmacy	018424	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	:	1457369548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLISS PHARMACY INC.

Provider Business Mailing Address
First Line	:	1590 MADISON AVE
Second Line	:	C/O BLISS PHARMACY INC.
City	:	NEW YORK
State	:	NY
Zip	:	10029-3816
Country	:	US
Telephone Number	:	212-427-4382
Fax Number	:	212-427-9019

Provider Business Practice Location Address
First Line	:	1590 MADISON AVE
Second Line	:	C/O BLISS PHARMACY INC.
City	:	NEW YORK
State	:	NY
Zip	:	10029-3816
Country	:	US
Telephone Number	:	212-427-4382
Fax Number	:	212-427-9019

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MOHAMMAD MOHSIN QADIR
Credential	:	R.PH
Telephone Number	:	212-427-4382

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	12/24/2007

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Directions to “BLISS PHARMACY INC. ” Practice Location

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