MEDICARE: MR. WILLIAM MEDITZ R.PH.

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	041701	NY

General Provider Information

NPI Number	:	1861717621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM MEDITZ R.PH.

Provider Business Mailing Address
First Line	:	2505 CARMEL AVE
Second Line	:	SUITES 110-111
City	:	BREWSTER
State	:	NY
Zip	:	10509-1155
Country	:	US
Telephone Number	:	845-278-8200
Fax Number	:	845-278-4340

Provider Business Practice Location Address
First Line	:	2505 CARMEL AVE
Second Line	:	SUITES 110-111
City	:	BREWSTER
State	:	NY
Zip	:	10509-1155
Country	:	US
Telephone Number	:	845-278-8200
Fax Number	:	845-278-4340

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

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	04/05/2010

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