MEDICARE: MR. ANDREW SIU 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	040470	NY

General Provider Information

NPI Number	:	1487783858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW SIU RPH

Provider Business Mailing Address
First Line	:	1852 KIMBALL ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4506
Country	:	US
Telephone Number	:	718-645-7411
Fax Number	:

Provider Business Practice Location Address
First Line	:	5912 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4121
Country	:	US
Telephone Number	:	718-439-0998
Fax Number	:

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

Provider Enumeration Date	:	03/03/2007
Last Update Date	:	07/08/2007

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