MEDICARE: BEKO S MANTEIN PHARMD.

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	19431	MD
2	183500000X	Pharmacist	RP444133	PA

General Provider Information

NPI Number	:	1548577000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEKO S MANTEIN PHARMD.

Provider Business Mailing Address
First Line	:	21800 N SHANGRI LA DR
Second Line	:	UNIT # 6
City	:	LEXINGTON PARK
State	:	MD
Zip	:	20653-1568
Country	:	US
Telephone Number	:	301-862-2134
Fax Number	:	301-862-9057

Provider Business Practice Location Address
First Line	:	21800 N SHANGRI LA DR
Second Line	:	UNIT # 6
City	:	LEXINGTON PARK
State	:	MD
Zip	:	20653-1568
Country	:	US
Telephone Number	:	301-862-2134
Fax Number	:	301-862-9057

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

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	09/07/2010

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