MEDICARE: SBSC 2 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	183500000X	Pharmacist	047040	NY

General Provider Information

NPI Number	:	1952674368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SBSC 2 LLC

Provider Business Mailing Address
First Line	:	7119 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1608
Country	:	US
Telephone Number	:	718-745-7119
Fax Number	:

Provider Business Practice Location Address
First Line	:	7119 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1608
Country	:	US
Telephone Number	:	718-745-7119
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	DR. SUCHANH CHUNG
Credential	:	PHARM D.
Telephone Number	:	718-745-7119

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	12/20/2012

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