MEDICARE: MR. GREGORY MICHAEL DECRESCENZO 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	PS19894	FL

General Provider Information

NPI Number	:	1912951294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY MICHAEL DECRESCENZO R.PH.

Provider Business Mailing Address
First Line	:	110 WATERWAY LN
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-3879
Country	:	US
Telephone Number	:	772-567-2555
Fax Number	:	772-567-0013

Provider Business Practice Location Address
First Line	:	3721 10TH CT
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6559
Country	:	US
Telephone Number	:	772-567-2555
Fax Number	:	772-567-0013

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/09/2007

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