MEDICARE: VANDERVEER PHARMACY INC.

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	007680	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	:	1508861758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANDERVEER PHARMACY INC.

Provider Business Mailing Address
First Line	:	1887 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7917
Country	:	US
Telephone Number	:	718-282-2927
Fax Number	:	718-284-2284

Provider Business Practice Location Address
First Line	:	1887 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7917
Country	:	US
Telephone Number	:	718-282-2927
Fax Number	:	718-284-2284

Authorized Official
Title or Position	:	CORPORATE SECTRETARY
Name	:	ALEX PERCHUK
Credential	:	RPH
Telephone Number	:	718-835-2000

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	03/26/2009

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