MEDICARE: SEA BREEZE PHARMACY & MEDICAL SUPPLY 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

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	:	1891961918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEA BREEZE PHARMACY & MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	1129 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5903
Country	:	US
Telephone Number	:	718-646-0660
Fax Number	:	347-587-6214

Provider Business Practice Location Address
First Line	:	1129 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5903
Country	:	US
Telephone Number	:	718-646-0660
Fax Number	:	347-587-6214

Authorized Official
Title or Position	:	SP
Name	:	MRS. SANA CHALIK
Credential	:	PHARMACIST
Telephone Number	:	718-646-0660

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	07/10/2025

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