MEDICARE: FARMACIA SELECTA

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	019468	NY
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3389930	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1780799726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACIA SELECTA

Provider Business Mailing Address
First Line	:	88 SEIGEL ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-3203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 SEIGEL ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-3203
Country	:	US
Telephone Number	:	718-387-2426
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARVA WALME
Credential	:
Telephone Number	:	718-387-2426

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	03/07/2011

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