MEDICARE: REXCARE 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	032994	NY

General Provider Information

NPI Number	:	1871994202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REXCARE PHARMACY INC.

Provider Business Mailing Address
First Line	:	PO BOX 130053
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-0053
Country	:	US
Telephone Number	:	718-484-7400
Fax Number	:	718-484-7440

Provider Business Practice Location Address
First Line	:	259 TROY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-3601
Country	:	US
Telephone Number	:	718-484-7400
Fax Number	:	718-484-7440

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHINEDU M AGBASIONWE
Credential	:
Telephone Number	:	718-484-7400

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	07/30/2015

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