MEDICARE: PETER E LEVIS 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	041904	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041904	OTHER	NY	NYS LICENSE NUMBER

General Provider Information

NPI Number	:	1417096793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER E LEVIS R.PH.

Provider Business Mailing Address
First Line	:	3519 31ST AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-1408
Country	:	US
Telephone Number	:	718-267-8063
Fax Number	:	718-267-8562

Provider Business Practice Location Address
First Line	:	3519 31ST AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-1408
Country	:	US
Telephone Number	:	718-267-8063
Fax Number	:	718-267-8562

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	06/27/2022

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Directions to “ PETER E LEVIS R.PH.” Practice Location

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