MEDICARE: NATIONAL SPECIALITY 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	3336C0004X	Compounding Pharmacy
2	3336S0011X	Specialty Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336C0003X	Community/Retail Pharmacy	029156	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
2	3360726	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1528213246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL SPECIALITY PHARMACY LLC

Provider Business Mailing Address
First Line	:	1336 PENINSULA BLVD
Second Line	:
City	:	HEWLETT
State	:	NY
Zip	:	11557-1226
Country	:	US
Telephone Number	:	516-791-6700
Fax Number	:	516-791-8324

Provider Business Practice Location Address
First Line	:	1336 PENINSULA BLVD
Second Line	:
City	:	HEWLETT
State	:	NY
Zip	:	11557-1226
Country	:	US
Telephone Number	:	516-791-6700
Fax Number	:	516-791-8324

Authorized Official
Title or Position	:	OWNER
Name	:	NINO CARNOVALE
Credential	:
Telephone Number	:	516-791-6700

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	01/17/2012

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Directions to “NATIONAL SPECIALITY PHARMACY LLC ” Practice Location

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