MEDICARE: SHANTI PHARMACY CORP

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	020652	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1508842931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANTI PHARMACY CORP

Provider Business Mailing Address
First Line	:	5105 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3511
Country	:	US
Telephone Number	:	718-922-3400
Fax Number	:	718-922-0348

Provider Business Practice Location Address
First Line	:	5105 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3511
Country	:	US
Telephone Number	:	718-922-3400
Fax Number	:	718-922-0348

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. MILIND S SUVARNAKAR
Credential	:	PHARMACIST
Telephone Number	:	718-922-3400

Provider Enumeration Date	:	12/18/2005
Last Update Date	:	02/13/2024

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Directions to “SHANTI PHARMACY CORP ” Practice Location

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