MEDICARE: ANDREW NYE

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	28RI03562800	NJ

General Provider Information

NPI Number	:	1629401393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW NYE

Provider Business Mailing Address
First Line	:	16 HOLLY CT
Second Line	:
City	:	HIGHLAND PARK
State	:	NJ
Zip	:	08904-1920
Country	:	US
Telephone Number	:	856-506-1836
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 PARK BLVD
Second Line	:
City	:	WILDWOOD
State	:	NJ
Zip	:	08260-1428
Country	:	US
Telephone Number	:	609-522-1291
Fax Number	:

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

Provider Enumeration Date	:	08/16/2013
Last Update Date	:	08/16/2013

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Directions to “ ANDREW NYE ” Practice Location

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