MEDICARE: ROBELEN CHEMISTS

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	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	021483	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2060428	OTHER		PK

General Provider Information

NPI Number	:	1861517948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBELEN CHEMISTS

Provider Business Mailing Address
First Line	:	100 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-5516
Country	:	US
Telephone Number	:	212-682-2817
Fax Number	:	212-682-6192

Provider Business Practice Location Address
First Line	:	100 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-5516
Country	:	US
Telephone Number	:	212-682-2817
Fax Number	:	212-682-6192

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	LEONARD GOLDSTEIN
Credential	:
Telephone Number	:	212-682-2817

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	04/21/2016

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