MEDICARE: MRS. PHYLLIS A BANOUB 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	28RI01596500	NJ

General Provider Information

NPI Number	:	1134348576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PHYLLIS A BANOUB RPH

Provider Business Mailing Address
First Line	:	2 VIRGIL RD
Second Line	:
City	:	NORWOOD
State	:	NJ
Zip	:	07648-1245
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 RIVER RD
Second Line	:
City	:	NEW MILFORD
State	:	NJ
Zip	:	07646-3127
Country	:	US
Telephone Number	:	201-967-1700
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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