MEDICARE: KVS 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	025109	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

General Provider Information

NPI Number	:	1659356012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KVS PHARMACY INC.

Provider Business Mailing Address
First Line	:	11210 SPRINGFIELD BLVD
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-2650
Country	:	US
Telephone Number	:	718-464-7777
Fax Number	:	718-776-0388

Provider Business Practice Location Address
First Line	:	112-10 SPRINGFIELD BLVD
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-2650
Country	:	US
Telephone Number	:	718-464-7777
Fax Number	:	718-776-0388

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. VASANT SHAH
Credential	:
Telephone Number	:	718-464-7777

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	10/23/2008

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