MEDICARE: VERNON BLVD 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	019391	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2064542	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457396988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERNON BLVD PHARMACY INC

Provider Business Mailing Address
First Line	:	4815 VERNON BLVD
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5616
Country	:	US
Telephone Number	:	718-361-7390
Fax Number	:	718-729-9613

Provider Business Practice Location Address
First Line	:	4815 VERNON BLVD
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5616
Country	:	US
Telephone Number	:	718-361-7390
Fax Number	:	718-729-9613

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA SCHIPPER
Credential	:	RPH
Telephone Number	:	718-361-7390

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	04/13/2021

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Directions to “VERNON BLVD PHARMACY INC ” Practice Location

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