MEDICARE: HAVEN PHARMACY

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	025828	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	3331307	OTHER	NY	NCPDP

General Provider Information

NPI Number	:	1811903594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN PHARMACY

Provider Business Mailing Address
First Line	:	1211 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4108
Country	:	US
Telephone Number	:	718-382-9616
Fax Number	:	718-382-9615

Provider Business Practice Location Address
First Line	:	1211 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4108
Country	:	US
Telephone Number	:	718-382-9616
Fax Number	:	718-382-9615

Authorized Official
Title or Position	:	RPH, SP, SECRETARY
Name	:	VIKTORIA GRINBLAT
Credential	:
Telephone Number	:	718-382-9616

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	09/30/2009

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Directions to “HAVEN PHARMACY ” Practice Location

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