MEDICARE: OUR TOWN 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1881229961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR TOWN PHARMACY, INC.

Provider Business Mailing Address
First Line	:	6945 GRAND AVE
Second Line	:
City	:	MASPETH
State	:	NY
Zip	:	11378-1825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6945 GRAND AVE
Second Line	:
City	:	MASPETH
State	:	NY
Zip	:	11378-1825
Country	:	US
Telephone Number	:	917-337-0431
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL GELBINOVICH
Credential	:
Telephone Number	:	917-337-0431

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	11/21/2020

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