MEDICARE: DR. MARC THOMAS LEVATINO 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	071941	NY

General Provider Information

NPI Number	:	1194542118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC THOMAS LEVATINO RPH

Provider Business Mailing Address
First Line	:	70 GRASMERE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1565
Country	:	US
Telephone Number	:	917-213-5110
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2576
Country	:	US
Telephone Number	:	718-351-7363
Fax Number	:

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

Provider Enumeration Date	:	09/21/2024
Last Update Date	:	09/21/2024

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