MEDICARE: MR. CECIL ERIC NELSON RPH

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	6974	MD

General Provider Information

NPI Number	:	1033216403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CECIL ERIC NELSON RPH

Provider Business Mailing Address
First Line	:	205 FENDER CT
Second Line	:
City	:	HAVRE DE GRACE
State	:	MD
Zip	:	21078-4109
Country	:	US
Telephone Number	:	410-939-9375
Fax Number	:

Provider Business Practice Location Address
First Line	:	BUILDING 361
Second Line	:
City	:	PERRY POINT
State	:	MD
Zip	:	21902-0000
Country	:	US
Telephone Number	:	410-642-2411
Fax Number	:	410-642-1883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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