Provider Demographics
NPI:1700209962
Name:MEDCAL PHARMACY LLC
Entity Type:Organization
Organization Name:MEDCAL PHARMACY LLC
Other - Org Name:MEDCAL PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-331-2200
Mailing Address - Street 1:2361 NOSTRAND AVE STE 901
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3953
Mailing Address - Country:US
Mailing Address - Phone:718-331-2200
Mailing Address - Fax:718-331-2202
Practice Address - Street 1:6010 BAY PKWY STE 803
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6081
Practice Address - Country:US
Practice Address - Phone:718-331-2200
Practice Address - Fax:718-331-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0323553336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144192OtherPK
NY03873943Medicaid
NY03873943Medicaid