MEDICARE: AHYME DEPAZ-STARCIC 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	28RI02554100	NJ

General Provider Information

NPI Number	:	1033418561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHYME DEPAZ-STARCIC RPH

Provider Business Mailing Address
First Line	:	172 6TH ST
Second Line	:	APT#3
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-1621
Country	:	US
Telephone Number	:	201-945-3039
Fax Number	:

Provider Business Practice Location Address
First Line	:	714 SUMMIT AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3429
Country	:	US
Telephone Number	:	201-866-4021
Fax Number	:

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

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	03/23/2011

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