MEDICARE: MEDICINE CENTER RX LLC

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	029274	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3360221	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1467607234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICINE CENTER RX LLC

Provider Business Mailing Address
First Line	:	92 E 167TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-8203
Country	:	US
Telephone Number	:	718-410-2814
Fax Number	:	718-410-2824

Provider Business Practice Location Address
First Line	:	92 E 167TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-8203
Country	:	US
Telephone Number	:	718-410-2814
Fax Number	:	718-410-2824

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NEERAJ TIRUNAGARI
Credential	:
Telephone Number	:	718-410-2814

Provider Enumeration Date	:	11/20/2008
Last Update Date	:	02/01/2023

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Directions to “MEDICINE CENTER RX LLC ” Practice Location

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