MEDICARE: MR. KEVIN MARTUSCELLO R.PH.

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	041911	NY

General Provider Information

NPI Number	:	1083953822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN MARTUSCELLO R.PH.

Provider Business Mailing Address
First Line	:	9 ERINN CT
Second Line	:
City	:	WILTON
State	:	NY
Zip	:	12831-2507
Country	:	US
Telephone Number	:	518-871-1722
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 ERINN CT
Second Line	:
City	:	WILTON
State	:	NY
Zip	:	12831-2507
Country	:	US
Telephone Number	:	518-871-1722
Fax Number	:

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

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	02/13/2013

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