MEDICARE: DETRONET.COM LLC

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
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1760961262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DETRONET.COM LLC

Provider Business Mailing Address
First Line	:	2632 ADAM CLAYTON POWELL JR BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-2601
Country	:	US
Telephone Number	:	917-409-3219
Fax Number	:	917-409-3179

Provider Business Practice Location Address
First Line	:	2632 ADAM CLAYTON POWELL JR BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-2601
Country	:	US
Telephone Number	:	646-850-1932
Fax Number	:	646-931-1951

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	SALAH K ISMAIL
Credential	:	PHARMACIST
Telephone Number	:	347-792-1545

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	03/06/2024

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Directions to “DETRONET.COM LLC ” Practice Location

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