MEDICARE: ATLANTIC BARCLAYS 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	3336C0003X	Community/Retail Pharmacy	033863	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2153866	OTHER		PK

General Provider Information

NPI Number	:	1780051987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC BARCLAYS PHARMACY INC

Provider Business Mailing Address
First Line	:	2061 ATLANTIC AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-3202
Country	:	US
Telephone Number	:	917-966-9696
Fax Number	:	917-966-9697

Provider Business Practice Location Address
First Line	:	2061 ATLANTIC AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-3202
Country	:	US
Telephone Number	:	917-966-9696
Fax Number	:	917-966-9697

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JENNIFER PAUL
Credential	:
Telephone Number	:	917-966-9696

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	09/09/2015

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