MEDICARE: MR. JOSEPH ANTHONY OLIVERI SR. R. P.

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	28RI01311500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28RI01311500	OTHER	NJ	PHARMACIST

General Provider Information

NPI Number	:	1366597262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH ANTHONY OLIVERI SR. R. P.

Provider Business Mailing Address
First Line	:	410 LAFAYETTE AVE
Second Line	:
City	:	WYCKOFF
State	:	NJ
Zip	:	07481-3009
Country	:	US
Telephone Number	:	201-612-1826
Fax Number	:

Provider Business Practice Location Address
First Line	:	678 WYCKOFF AVE
Second Line	:
City	:	WYCKOFF
State	:	NJ
Zip	:	07481-1430
Country	:	US
Telephone Number	:	201-891-3333
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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