MEDICARE: THRIFTWAY HYLAN BLVD DRUG 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	023654	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3343364	OTHER		OTHER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841387057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIFTWAY HYLAN BLVD DRUG CORP

Provider Business Mailing Address
First Line	:	2728 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2728 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-4658
Country	:	US
Telephone Number	:	718-987-0700
Fax Number	:	718-987-7644

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HAL EPSTEIN
Credential	:
Telephone Number	:	718-987-0700

Provider Enumeration Date	:	10/07/2006
Last Update Date	:	09/13/2007

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