MEDICARE: RAFAIL B MATATOV 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	047049	NY

General Provider Information

NPI Number	:	1972775989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAIL B MATATOV RPH

Provider Business Mailing Address
First Line	:	2818 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-2608
Country	:	US
Telephone Number	:	718-235-6394
Fax Number	:	718-894-3903

Provider Business Practice Location Address
First Line	:	2818 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-2608
Country	:	US
Telephone Number	:	718-235-6394
Fax Number	:	718-894-3903

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

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	03/31/2008

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