MEDICARE: DRUG MART PHARMACY CORP

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	020049	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	2065550	OTHER		PK

General Provider Information

NPI Number	:	1790832855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRUG MART PHARMACY CORP

Provider Business Mailing Address
First Line	:	4914 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3418
Country	:	US
Telephone Number	:	718-633-4900
Fax Number	:	718-435-0324

Provider Business Practice Location Address
First Line	:	4914 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3418
Country	:	US
Telephone Number	:	718-633-4900
Fax Number	:	718-435-0324

Authorized Official
Title or Position	:	SUPERVISING PHRM
Name	:	DOMINICK LETTIERI
Credential	:	RPH
Telephone Number	:	718-633-4900

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	11/29/2016

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Directions to “DRUG MART PHARMACY CORP ” Practice Location

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