MEDICARE: QUEENS EXPRESS 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	028747	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2070136	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649448143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEENS EXPRESS PHARMACY CORP

Provider Business Mailing Address
First Line	:	3454 JUNCTION BLVD
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3829
Country	:	US
Telephone Number	:	718-565-1005
Fax Number	:	718-565-1004

Provider Business Practice Location Address
First Line	:	3454 JUNCTION BLVD
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3829
Country	:	US
Telephone Number	:	718-565-1005
Fax Number	:	718-565-1004

Authorized Official
Title or Position	:	OWNER
Name	:	WANAS KHALIL
Credential	:
Telephone Number	:	718-565-1009

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	03/08/2018

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Directions to “QUEENS EXPRESS PHARMACY CORP ” Practice Location

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