MEDICARE: PUNITA J. KOTHARI 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	042529-1	NY

General Provider Information

NPI Number	:	1629157136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PUNITA J. KOTHARI RPH

Provider Business Mailing Address
First Line	:	4615 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1254
Country	:	US
Telephone Number	:	718-972-2780
Fax Number	:	718-435-8081

Provider Business Practice Location Address
First Line	:	4615 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1254
Country	:	US
Telephone Number	:	718-972-2780
Fax Number	:	718-435-8081

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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