MEDICARE: MR. CHARLES B. FISHMAN 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	22302	CA
2	183500000X	Pharmacist	23889	NY

General Provider Information

NPI Number	:	1881914364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES B. FISHMAN R.PH.

Provider Business Mailing Address
First Line	:	3306 92ND ST APT 1M
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3306 92ND ST APT 1M
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1808
Country	:	US
Telephone Number	:	718-507-8799
Fax Number	:

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

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	11/03/2010

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Directions to “ MR. CHARLES B. FISHMAN R.PH.” Practice Location

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