MEDICARE: SELVIN SOBY PHARMD

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	065138-1	NY

General Provider Information

NPI Number	:	1114543238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELVIN SOBY PHARMD

Provider Business Mailing Address
First Line	:	21 LAKE ST APT 1E
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10603-3864
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 LAKE ST APT 1E
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10603-3864
Country	:	US
Telephone Number	:	201-805-5383
Fax Number	:

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

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	06/24/2020

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