MEDICARE: MS. SUZANNA GLUZMAN

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	042753	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042753	OTHER	NY	PHARMACIST

General Provider Information

NPI Number	:	1033432018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNA GLUZMAN

Provider Business Mailing Address
First Line	:	1604 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6007
Country	:	US
Telephone Number	:	718-375-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6007
Country	:	US
Telephone Number	:	718-375-8900
Fax Number	:

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

Provider Enumeration Date	:	03/05/2010
Last Update Date	:	09/20/2012

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