MEDICARE: BRANAC NY 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1548874472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANAC NY LLC

Provider Business Mailing Address
First Line	:	1047 SURF AVE FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2810
Country	:	US
Telephone Number	:	917-830-2522
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 MERMAID AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2006
Country	:	US
Telephone Number	:	718-333-2525
Fax Number	:

Authorized Official
Title or Position	:	PIC
Name	:	ERICA MOISEYEV
Credential	:
Telephone Number	:	718-333-2525

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	10/04/2023

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Directions to “BRANAC NY LLC ” Practice Location

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