MEDICARE: KINGSWAY 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
2	3336C0003X	Community/Retail Pharmacy	024946	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	2062841	OTHER		PK

General Provider Information

NPI Number	:	1548338783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGSWAY PHARMACY CORP

Provider Business Mailing Address
First Line	:	1402 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2004
Country	:	US
Telephone Number	:	718-382-7700
Fax Number	:	718-645-8655

Provider Business Practice Location Address
First Line	:	1402 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2004
Country	:	US
Telephone Number	:	718-382-7700
Fax Number	:	718-645-8655

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IGOR MOSHCHINSKY
Credential	:
Telephone Number	:	718-382-7700

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	03/06/2017

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Directions to “KINGSWAY PHARMACY CORP ” Practice Location

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