MEDICARE: SOEY RX INC

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	031018	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2133234	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558640532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOEY RX INC

Provider Business Mailing Address
First Line	:	6902 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1305
Country	:	US
Telephone Number	:	718-238-2444
Fax Number	:	718-921-6104

Provider Business Practice Location Address
First Line	:	6902 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1305
Country	:	US
Telephone Number	:	718-238-2444
Fax Number	:	718-921-6104

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. MINA AZER
Credential	:	PHARMD
Telephone Number	:	718-238-2444

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	03/18/2021

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Directions to “SOEY RX INC ” Practice Location

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