MEDICARE: 1491 DEKALB 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	333600000X	Pharmacy	018542	NY
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3383243	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760547186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1491 DEKALB AVE PHARMACY INC

Provider Business Mailing Address
First Line	:	1472 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1472 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3604
Country	:	US
Telephone Number	:	718-381-0018
Fax Number	:	718-456-4983

Authorized Official
Title or Position	:	PRES
Name	:	KAZI ANAM
Credential	:
Telephone Number	:	718-381-0018

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	09/11/2025

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