=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699083907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABE FARD RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2010
-----------------------------------------------------
Last Update Date | 09/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 CRESTWOOD PL
-----------------------------------------------------
City | GREAT NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11024-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-720-2252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 CRESTWOOD PL
-----------------------------------------------------
City | GREAT NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11024-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-720-2252
-----------------------------------------------------
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 | 047623
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------