MEDICARE: MATTHEW J OSTOYICH 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	30273	NY

General Provider Information

NPI Number	:	1790963619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW J OSTOYICH RPH

Provider Business Mailing Address
First Line	:	4539 RT 9G
Second Line	:
City	:	GERMANTOWN
State	:	NY
Zip	:	12526-5127
Country	:	US
Telephone Number	:	518-537-4461
Fax Number	:	518-537-4461

Provider Business Practice Location Address
First Line	:	1301 ULSTER AVE
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-1514
Country	:	US
Telephone Number	:	845-336-5955
Fax Number	:

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

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/01/2008

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