MEDICARE: MISHKINS PHARMA 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	033076	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2148254	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467869495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISHKINS PHARMA LLC

Provider Business Mailing Address
First Line	:	1714 AMSTERDAM AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-4602
Country	:	US
Telephone Number	:	212-926-2801
Fax Number	:	212-862-4715

Provider Business Practice Location Address
First Line	:	1714 AMSTERDAM AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-4602
Country	:	US
Telephone Number	:	212-926-2801
Fax Number	:	212-862-4715

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST / MANAGER
Name	:	NAREEN ADUSUMELLI
Credential	:
Telephone Number	:	212-926-2801

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	10/02/2020

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Directions to “MISHKINS PHARMA LLC ” Practice Location

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