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NPI Code Detail

MEDICARE: FIVE STAR PHARMACY INC

MEDICARE: FIVE STAR 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
1333600000XPharmacy

General Provider Information

NPI Number : 1902940307
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIVE STAR PHARMACY INC
Provider Business Mailing Address
First Line : 4125 18TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11218-5709
Country : US
Telephone Number : 718-686-8900
Fax Number : 718-686-8910
Provider Business Practice Location Address
First Line : 4125 18TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11218-5709
Country : US
Telephone Number : 718-686-8900
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SOFIYA GUTMAN
Credential :
Telephone Number : 718-686-8900
Provider Enumeration Date : 02/18/2007
Last Update Date : 12/17/2007

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Directions to “FIVE STAR PHARMACY INC ” Practice Location

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