MEDICARE: MR. EDWARD VALENTINE GAUSS RPH.

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	032185	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	032185	OTHER	NY	NY STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1124296330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD VALENTINE GAUSS RPH.

Provider Business Mailing Address
First Line	:	625 HARVARD AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2636
Country	:	US
Telephone Number	:	516-379-0122
Fax Number	:

Provider Business Practice Location Address
First Line	:	1686 MERRICK RD
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-4538
Country	:	US
Telephone Number	:	516-378-9423
Fax Number	:

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

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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