MEDICARE: DR. RICHARD ARENA R.PH., PH.D., CDE

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	1835P1200X	Pharmacotherapy Pharmacist	29073	NY

General Provider Information

NPI Number	:	1114921814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ARENA R.PH., PH.D., CDE

Provider Business Mailing Address
First Line	:	114 BUCKNELL RD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-5330
Country	:	US
Telephone Number	:	516-825-0563
Fax Number	:

Provider Business Practice Location Address
First Line	:	8268 164TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-1140
Country	:	US
Telephone Number	:	718-883-3887
Fax Number	:	718-883-6122

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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