MEDICARE: ALBERT AMIROV

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	28RI02481700	NJ
2	183500000X	Pharmacist	045852-1	NY

General Provider Information

NPI Number	:	1700020476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT AMIROV

Provider Business Mailing Address
First Line	:	123 ANDERSON ST
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-3503
Country	:	US
Telephone Number	:	201-488-0654
Fax Number	:	201-883-1619

Provider Business Practice Location Address
First Line	:	123 ANDERSON ST
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-3503
Country	:	US
Telephone Number	:	201-488-0654
Fax Number	:	201-883-1619

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

Provider Enumeration Date	:	04/26/2009
Last Update Date	:	07/26/2014

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Directions to “ ALBERT AMIROV ” Practice Location

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