MEDICARE: GENE VAYNERCHUK 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	28RI02463100	NJ

General Provider Information

NPI Number	:	1679854368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE VAYNERCHUK RPH

Provider Business Mailing Address
First Line	:	57 MEADOWLARK RD
Second Line	:
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6020
Country	:	US
Telephone Number	:	908-237-0244
Fax Number	:	908-237-9240

Provider Business Practice Location Address
First Line	:	29 ROUTE 31
Second Line	:
City	:	FLEMINGTON
State	:	NJ
Zip	:	08822-1634
Country	:	US
Telephone Number	:	908-237-0244
Fax Number	:	908-237-9240

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

Provider Enumeration Date	:	09/08/2011
Last Update Date	:	09/08/2011

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