MEDICARE: MR. BASSAM A AMIN PHARAMCIST

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	028056	NY

General Provider Information

NPI Number	:	1790851954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BASSAM A AMIN PHARAMCIST

Provider Business Mailing Address
First Line	:	205 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-6421
Country	:	US
Telephone Number	:	718-923-1122
Fax Number	:	718-923-9811

Provider Business Practice Location Address
First Line	:	205 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-6421
Country	:	US
Telephone Number	:	718-923-1122
Fax Number	:	718-923-9811

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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