MEDICARE: BOSTON PHARMA 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	034264	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	2148253	OTHER		PK

General Provider Information

NPI Number	:	1942609904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON PHARMA LLC

Provider Business Mailing Address
First Line	:	7924 FLATLANDS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3532
Country	:	US
Telephone Number	:	718-872-5142
Fax Number	:	718-872-5137

Provider Business Practice Location Address
First Line	:	7924 FLATLANDS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3532
Country	:	US
Telephone Number	:	718-872-5142
Fax Number	:	718-872-5137

Authorized Official
Title or Position	:	MANAGER/SUPERVISING PHARMACIST
Name	:	RANGA SANTOSH NARLA
Credential	:
Telephone Number	:	718-872-5142

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	05/26/2026

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Directions to “BOSTON PHARMA LLC ” Practice Location

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