MEDICARE: MR. MORRIS FATIHA

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	048521	NY

General Provider Information

NPI Number	:	1346421070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MORRIS FATIHA

Provider Business Mailing Address
First Line	:	1802 AVENUE V
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4504
Country	:	US
Telephone Number	:	718-627-2689
Fax Number	:	718-622-0289

Provider Business Practice Location Address
First Line	:	302 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3106
Country	:	US
Telephone Number	:	718-871-1112
Fax Number	:	718-622-0289

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

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	11/21/2007

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