MEDICARE: M & D PHARMACY LLC

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	029773	NY

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
2	3364534	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1902044670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M & D PHARMACY LLC

Provider Business Mailing Address
First Line	:	17 W 125TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4513
Country	:	US
Telephone Number	:	212-831-0200
Fax Number	:	212-831-0230

Provider Business Practice Location Address
First Line	:	17 W 125TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4513
Country	:	US
Telephone Number	:	212-831-0200
Fax Number	:	212-831-0230

Authorized Official
Title or Position	:	PHARMACIST
Name	:	ATULKUMAR PATEL
Credential	:
Telephone Number	:	212-831-0200

Provider Enumeration Date	:	02/03/2009
Last Update Date	:	10/02/2012

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Directions to “M & D PHARMACY LLC ” Practice Location

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