MEDICARE: MR. RAJ PANDE R.PH

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	053280-1	NY
2	183500000X	Pharmacist	29711	TX

General Provider Information

NPI Number	:	1275855991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAJ PANDE R.PH

Provider Business Mailing Address
First Line	:	384 MEADOW DR
Second Line	:	APT #4
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2821
Country	:	US
Telephone Number	:	832-797-6583
Fax Number	:

Provider Business Practice Location Address
First Line	:	1066 PAYNE AVE
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2720
Country	:	US
Telephone Number	:	716-694-0323
Fax Number	:	716-693-1506

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

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	02/22/2010

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Directions to “ MR. RAJ PANDE R.PH” Practice Location

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