MEDICARE: CHELSEA CARE RX 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	035782	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2173091	OTHER		PK

General Provider Information

NPI Number	:	1578088647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHELSEA CARE RX CORP

Provider Business Mailing Address
First Line	:	327 8TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-4807
Country	:	US
Telephone Number	:	212-255-5522
Fax Number	:	212-255-4686

Provider Business Practice Location Address
First Line	:	327 8TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-4807
Country	:	US
Telephone Number	:	212-255-5522
Fax Number	:	212-255-4686

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JACOB YOUNATANOV
Credential	:
Telephone Number	:	212-255-5522

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	04/19/2018

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Directions to “CHELSEA CARE RX CORP ” Practice Location

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