MEDICARE: CHURCH AVE PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	333600000X	Pharmacy
2	3336C0002X	Clinic Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1477246536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHURCH AVE PHARMACY INC

Provider Business Mailing Address
First Line	:	1810 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3706
Country	:	US
Telephone Number	:	718-941-2200
Fax Number	:	718-941-2300

Provider Business Practice Location Address
First Line	:	1810 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3706
Country	:	US
Telephone Number	:	718-941-2200
Fax Number	:	718-941-2300

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	ZOYA PRITSKER
Credential	:
Telephone Number	:	718-941-2200

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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