MEDICARE: CANAAN 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	3336C0003X	Community/Retail Pharmacy	017260	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	:	1669408951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANAAN PHARMACY INC.

Provider Business Mailing Address
First Line	:	6914 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1507
Country	:	US
Telephone Number	:	718-779-4523
Fax Number	:	718-779-7814

Provider Business Practice Location Address
First Line	:	6914 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1507
Country	:	US
Telephone Number	:	718-779-4523
Fax Number	:	718-779-7814

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KRISHNA CHALUVADI
Credential	:
Telephone Number	:	718-293-9596

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	04/27/2018

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