MEDICARE: 353 EMPIRE 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	3336S0011X	Specialty Pharmacy
2	3336C0003X	Community/Retail Pharmacy

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

General Provider Information

NPI Number	:	1871506337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	353 EMPIRE PHARMACY INC

Provider Business Mailing Address
First Line	:	505 UNION AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-1395
Country	:	US
Telephone Number	:	718-467-0918
Fax Number	:	718-774-3078

Provider Business Practice Location Address
First Line	:	505 UNION AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-1395
Country	:	US
Telephone Number	:	718-467-0918
Fax Number	:	718-774-3078

Authorized Official
Title or Position	:	OWNER
Name	:	NUCHEM JACOBOWITZ
Credential	:
Telephone Number	:	718-687-0497

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	02/24/2021

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