MEDICARE: SAINT TERESA'S 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
1	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	039522	OTHER	NY	PHARMACY LICENSE

General Provider Information

NPI Number	:	1629716956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT TERESA'S PHARMACY INC

Provider Business Mailing Address
First Line	:	3849 10TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-1850
Country	:	US
Telephone Number	:	212-304-4541
Fax Number	:

Provider Business Practice Location Address
First Line	:	3849 10TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-1850
Country	:	US
Telephone Number	:	212-304-4541
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. OLGA XANTHOPOULOS
Credential	:
Telephone Number	:	212-304-4541

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	05/25/2022

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