MEDICARE: SUPER CARE RX 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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1902382534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPER CARE RX INC

Provider Business Mailing Address
First Line	:	1056 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2303
Country	:	US
Telephone Number	:	718-421-5533
Fax Number	:	718-421-7440

Provider Business Practice Location Address
First Line	:	1056 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2303
Country	:	US
Telephone Number	:	718-421-5533
Fax Number	:	718-421-7440

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TAIMOOR FAROOQ
Credential	:
Telephone Number	:	718-421-5533

Provider Enumeration Date	:	07/17/2018
Last Update Date	:	07/17/2018

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