=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619110137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC B ASARERPH RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2009
-----------------------------------------------------
Last Update Date | 04/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 568 W 125TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-3407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-865-2383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124A SOUTH 13TH AVENUE FLR# 2
-----------------------------------------------------
City | MT. VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-439-2639
-----------------------------------------------------
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 | 053137-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI02911700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------