MEDICARE: KINGS HWY PHARMACY AND MEDICAL SUPPLY 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	027329	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2064708	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467550319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS HWY PHARMACY AND MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	1671 E 13TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1101
Country	:	US
Telephone Number	:	718-375-5757
Fax Number	:	718-375-0364

Provider Business Practice Location Address
First Line	:	1416 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2004
Country	:	US
Telephone Number	:	718-375-5757
Fax Number	:

Authorized Official
Title or Position	:	RPH
Name	:	IGOR SHOYKHET
Credential	:	RPH
Telephone Number	:	718-375-5757

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	03/08/2018

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