=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144403627
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK TUROK RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2007
-----------------------------------------------------
Last Update Date | 12/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2150 BROADWAY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-8208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-441-1756
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 88 FOXWOOD PL
-----------------------------------------------------
City | MORGANVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07751-1718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-441-1756
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 032044
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------