MEDICARE: MS. THERESA A SOWINSKI

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	048030	NY

General Provider Information

NPI Number	:	1932383395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA A SOWINSKI

Provider Business Mailing Address
First Line	:	6 SPRING GARDEN RD
Second Line	:
City	:	ROCKY POINT
State	:	NY
Zip	:	11778-9133
Country	:	US
Telephone Number	:	631-957-8694
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 MIDDLE COUNTRY RD
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-2542
Country	:	US
Telephone Number	:	631-924-0154
Fax Number	:

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

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	12/20/2007

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