MEDICARE: BROOKLYN DRUGS 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	025931	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	3331939	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1912989682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN DRUGS INC

Provider Business Mailing Address
First Line	:	7202 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7202 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2009
Country	:	US
Telephone Number	:	718-259-4445
Fax Number	:	718-259-0504

Authorized Official
Title or Position	:	PIC
Name	:	ROBERT FORKOSH
Credential	:	RPH
Telephone Number	:	718-259-4445

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	02/01/2008

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