MEDICARE: KINGS HIGHWAY CHEMISTS 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	018539	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	2062371	OTHER		PK

General Provider Information

NPI Number	:	1598852733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS HIGHWAY CHEMISTS INC

Provider Business Mailing Address
First Line	:	3402 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2607
Country	:	US
Telephone Number	:	718-258-5858
Fax Number	:	718-258-2600

Provider Business Practice Location Address
First Line	:	3402 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2607
Country	:	US
Telephone Number	:	718-258-5858
Fax Number	:	718-258-2600

Authorized Official
Title or Position	:	MANAGER
Name	:	ANDREW EPSTEIN
Credential	:	RPH
Telephone Number	:	718-258-5858

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	11/22/2016

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