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NPI Code Detail

MEDICARE: SHAKESPEARE PHARMACY LLC

MEDICARE: SHAKESPEARE PHARMACY LLC
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
13336C0003XCommunity/Retail Pharmacy029403NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13361211OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1811123466
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAKESPEARE PHARMACY LLC
Provider Business Mailing Address
First Line : 1252 SHAKESPEARE AVE
Second Line :
City : BRONX
State : NY
Zip : 10452-3012
Country : US
Telephone Number : 718-588-4100
Fax Number : 718-588-4200
Provider Business Practice Location Address
First Line : 1252 SHAKESPEARE AVE
Second Line :
City : BRONX
State : NY
Zip : 10452-3012
Country : US
Telephone Number : 718-588-4100
Fax Number : 718-588-4200
Authorized Official
Title or Position : PRESIDENT
Name : MUSHTAQ FAISAL
Credential :
Telephone Number : 718-588-4100
Provider Enumeration Date : 06/09/2009
Last Update Date : 10/26/2010

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Directions to “SHAKESPEARE PHARMACY LLC ” Practice Location

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