MEDICARE: YACOB 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

General Provider Information

NPI Number	:	1801233960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YACOB PHARMACY INC

Provider Business Mailing Address
First Line	:	1106 SAINT JOHNS PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-2699
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 SAINT JOHNS PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-2699
Country	:	US
Telephone Number	:	718-221-4805
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ISMAIL MOHAMED
Credential	:
Telephone Number	:	727-457-7539

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	11/26/2013

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