MEDICARE: DMITRIY R PERELMAN 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	048639	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	048639	OTHER	NY	NY STATE LICENSE

General Provider Information

NPI Number	:	1609857515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DMITRIY R PERELMAN PHARMD

Provider Business Mailing Address
First Line	:	1420 AVE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230
Country	:	US
Telephone Number	:	718-677-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3702
Country	:	US
Telephone Number	:	718-677-5800
Fax Number	:

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/08/2007

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