MEDICARE: BRITE 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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	027404	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	2067336	OTHER		PK

General Provider Information

NPI Number	:	1932114543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRITE PHARMACY INC

Provider Business Mailing Address
First Line	:	8319 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7320
Country	:	US
Telephone Number	:	718-424-1101
Fax Number	:	718-424-1299

Provider Business Practice Location Address
First Line	:	8319 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7320
Country	:	US
Telephone Number	:	718-424-1101
Fax Number	:	718-424-1299

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	KIM WONG
Credential	:
Telephone Number	:	718-424-1101

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	12/18/2016

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Directions to “BRITE PHARMACY INC ” Practice Location

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