MEDICARE: GEORGE C RONTIRIS 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	042377	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042377	OTHER	NY	NY STATE PHARMACY LICENSE

General Provider Information

NPI Number	:	1003955394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE C RONTIRIS RPH

Provider Business Mailing Address
First Line	:	PO BOX 6246
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-0246
Country	:	US
Telephone Number	:	718-267-8063
Fax Number	:

Provider Business Practice Location Address
First Line	:	3519 31ST AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-1408
Country	:	US
Telephone Number	:	718-267-8063
Fax Number	:

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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Directions to “ GEORGE C RONTIRIS RPH” Practice Location

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