MEDICARE: BROOKDALE PHARMA 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
2	3336C0003X	Community/Retail Pharmacy	030829	NY

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	2133081	OTHER		PK

General Provider Information

NPI Number	:	1780982256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKDALE PHARMA INC

Provider Business Mailing Address
First Line	:	2568 LINDEN BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-4904
Country	:	US
Telephone Number	:	718-485-0070
Fax Number	:	718-485-0188

Provider Business Practice Location Address
First Line	:	2568 LINDEN BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-4904
Country	:	US
Telephone Number	:	718-485-0070
Fax Number	:	718-485-0188

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KALPESH MAFATBHAI PATEL
Credential	:
Telephone Number	:	718-485-0070

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	09/30/2025

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Directions to “BROOKDALE PHARMA INC ” Practice Location

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