MEDICARE: 2196 FLATBUSH 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

General Provider Information

NPI Number	:	1750221974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2196 FLATBUSH PHARMACY INC.

Provider Business Mailing Address
First Line	:	2196 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4326
Country	:	US
Telephone Number	:	718-513-0938
Fax Number	:	718-513-0939

Provider Business Practice Location Address
First Line	:	2196 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4326
Country	:	US
Telephone Number	:	718-513-0938
Fax Number	:	718-513-0939

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	OBID MEYLIKULOV
Credential	:
Telephone Number	:	718-513-0938

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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