MEDICARE: NATES HUGUENOT PHARMACY 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1629526884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATES HUGUENOT PHARMACY CORP.

Provider Business Mailing Address
First Line	:	826 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2446
Country	:	US
Telephone Number	:	718-720-3710
Fax Number	:

Provider Business Practice Location Address
First Line	:	877 HUGUENOT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3920
Country	:	US
Telephone Number	:	718-509-4100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BORIS NATENZON
Credential	:
Telephone Number	:	917-734-4662

Provider Enumeration Date	:	09/16/2016
Last Update Date	:	09/16/2016

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