MEDICARE: CITY CARE 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
3	3336C0003X	Community/Retail Pharmacy	015266	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	3318210	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1972631638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY CARE PHARMACY INC

Provider Business Mailing Address
First Line	:	3449 21ST ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4721
Country	:	US
Telephone Number	:	718-729-5199
Fax Number	:	718-729-8845

Provider Business Practice Location Address
First Line	:	3449 21ST ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4721
Country	:	US
Telephone Number	:	718-729-5199
Fax Number	:	718-729-8845

Authorized Official
Title or Position	:	OWNER
Name	:	LIDAMI TORIBIO
Credential	:
Telephone Number	:	718-729-5199

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	05/24/2022

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Directions to “CITY CARE PHARMACY INC ” Practice Location

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