MEDICARE: THRIFT PHARMACY 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	3336C0003X	Community/Retail Pharmacy		NY

General Provider Information

NPI Number	:	1518230309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIFT PHARMACY LLC

Provider Business Mailing Address
First Line	:	1621 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-2615
Country	:	US
Telephone Number	:	718-282-4600
Fax Number	:	718-282-3815

Provider Business Practice Location Address
First Line	:	1621 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-2615
Country	:	US
Telephone Number	:	718-282-4600
Fax Number	:	718-282-3815

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GAUTAM KUMAR NIRMAL
Credential	:
Telephone Number	:	718-282-4600

Provider Enumeration Date	:	02/09/2012
Last Update Date	:	02/09/2012

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Directions to “THRIFT PHARMACY LLC ” Practice Location

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