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NPI Code Detail

MEDICARE: 3921 9TH AVE PHARMACY INC

MEDICARE: 3921 9TH AVE 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
13336C0003XCommunity/Retail Pharmacy

Other Identifiers

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

General Provider Information

NPI Number : 1700928207
Entity Type Code : Organization
Provider Name (Legal Business Name) : 3921 9TH AVE PHARMACY INC
Provider Business Mailing Address
First Line : 3921 9TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11232-3207
Country : US
Telephone Number : 718-435-7790
Fax Number : 718-871-8020
Provider Business Practice Location Address
First Line : 3921 9TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11232-3207
Country : US
Telephone Number : 718-435-7790
Fax Number : 718-871-8020
Authorized Official
Title or Position : PRESIDENT
Name : MRS. OLIVERA PERUNOVIC
Credential :
Telephone Number : 718-435-7790
Provider Enumeration Date : 02/12/2007
Last Update Date : 11/15/2012

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