MEDICARE: ALICIA PHARMA 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

General Provider Information

NPI Number	:	1538582275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALICIA PHARMA LLC

Provider Business Mailing Address
First Line	:	765 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-4203
Country	:	US
Telephone Number	:	718-774-7400
Fax Number	:	718-774-7404

Provider Business Practice Location Address
First Line	:	765 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-4203
Country	:	US
Telephone Number	:	718-774-7400
Fax Number	:	718-774-7404

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KRISHNA K INAPURI
Credential	:
Telephone Number	:	718-213-5585

Provider Enumeration Date	:	01/31/2014
Last Update Date	:	01/31/2014

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