MEDICARE: KINGS 7TH 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
1	3336S0011X	Specialty Pharmacy	035456	NY
2	3336C0003X	Community/Retail Pharmacy	035456	NY

General Provider Information

NPI Number	:	1710413109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS 7TH AVE PHARMACY INC

Provider Business Mailing Address
First Line	:	300 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-7251
Country	:	US
Telephone Number	:	718-499-5200
Fax Number	:	718-499-1299

Provider Business Practice Location Address
First Line	:	300 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-7251
Country	:	US
Telephone Number	:	718-499-5200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	RONALD DELGAUDIO
Credential	:
Telephone Number	:	917-921-5656

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	05/04/2017

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