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NPI Code Detail

MEDICARE: FUNMILAYO PHARMACY INC

MEDICARE: FUNMILAYO PHARMACY 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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0004XCompounding Pharmacy
33336C0003XCommunity/Retail Pharmacy021071NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22067102OTHERPK

General Provider Information

NPI Number : 1629139795
Entity Type Code : Organization
Provider Name (Legal Business Name) : FUNMILAYO PHARMACY INC
Provider Business Mailing Address
First Line : 1563 RALPH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-3127
Country : US
Telephone Number : 718-853-1110
Fax Number : 718-853-1717
Provider Business Practice Location Address
First Line : 1563 RALPH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-3127
Country : US
Telephone Number : 718-853-1110
Fax Number : 718-853-1717
Authorized Official
Title or Position : MANAGER
Name : PAT IDOWU
Credential :
Telephone Number : 718-853-1110
Provider Enumeration Date : 12/13/2006
Last Update Date : 11/29/2016

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Directions to “FUNMILAYO PHARMACY INC ” Practice Location

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