MEDICARE: GIGI SPECIALTY PHARMACY CORP.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336C0004X	Compounding Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1508337023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIGI SPECIALTY PHARMACY CORP.

Provider Business Mailing Address
First Line	:	55 PAGE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2611
Country	:	US
Telephone Number	:	917-593-0500
Fax Number	:	718-966-0800

Provider Business Practice Location Address
First Line	:	55 PAGE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2611
Country	:	US
Telephone Number	:	718-605-5550
Fax Number	:	718-966-0800

Authorized Official
Title or Position	:	PHARMACY SUPERVISOR/PHARMACY OWNER
Name	:	MRS. GIHAN F TADOROS
Credential	:	PHARMACIST
Telephone Number	:	917-593-0500

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	12/10/2018

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