MEDICARE: DEERFIELD PHARMACY

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	BD3077307	MA

General Provider Information

NPI Number	:	1083727234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEERFIELD PHARMACY

Provider Business Mailing Address
First Line	:	45 MAIN ST.
Second Line	:
City	:	S. DEERFIELD
State	:	MA
Zip	:	01373-1012
Country	:	US
Telephone Number	:	413-665-8143
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 MAIN ST.
Second Line	:
City	:	S. DEERFIELD
State	:	MA
Zip	:	01373-1012
Country	:	US
Telephone Number	:	413-665-8143
Fax Number	:

Authorized Official
Title or Position	:	RPH/OWNER
Name	:	MR. ROBERT FYDENKEVEZ
Credential	:
Telephone Number	:	413-665-8143

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	06/25/2008

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