MEDICARE: MR. SAUL NOVACK 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	30555	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30555	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1669642179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAUL NOVACK RPH

Provider Business Mailing Address
First Line	:	1245 61ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5303
Country	:	US
Telephone Number	:	718-853-8645
Fax Number	:	718-853-6469

Provider Business Practice Location Address
First Line	:	1260 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4911
Country	:	US
Telephone Number	:	718-853-8645
Fax Number	:

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

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	10/11/2009

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