MEDICARE: MILFORD MEDICAL LLC

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	333600000X	Pharmacy	PP481913	PA

General Provider Information

NPI Number	:	1083967913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILFORD MEDICAL LLC

Provider Business Mailing Address
First Line	:	113 7TH ST
Second Line	:	UNIT 2
City	:	MILFORD
State	:	PA
Zip	:	18337-1234
Country	:	US
Telephone Number	:	570-296-1095
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 7TH ST
Second Line	:	UNIT 2
City	:	MILFORD
State	:	PA
Zip	:	18337-1234
Country	:	US
Telephone Number	:	570-296-1095
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAYMOND IZZO
Credential	:
Telephone Number	:	570-296-1095

Provider Enumeration Date	:	10/16/2012
Last Update Date	:	10/16/2012

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Directions to “MILFORD MEDICAL LLC ” Practice Location

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