MEDICARE: DR. SVETLANA FEUDALE PHARMD

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	RP439482	PA

General Provider Information

NPI Number	:	1194037143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SVETLANA FEUDALE PHARMD

Provider Business Mailing Address
First Line	:	116 HORSESHOE DR
Second Line	:
City	:	MANTUA
State	:	NJ
Zip	:	08051-1332
Country	:	US
Telephone Number	:	267-825-5109
Fax Number	:

Provider Business Practice Location Address
First Line	:	9773 ROOSEVELT BLVD
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19114-1010
Country	:	US
Telephone Number	:	215-673-0747
Fax Number	:

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

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	07/07/2010

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