MEDICARE: MARAT BLUSTIN 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	044938	NY

General Provider Information

NPI Number	:	1154596070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARAT BLUSTIN RPH

Provider Business Mailing Address
First Line	:	83 MILLS AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4523
Country	:	US
Telephone Number	:	917-922-3204
Fax Number	:	718-648-4328

Provider Business Practice Location Address
First Line	:	2617 E 16TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3801
Country	:	US
Telephone Number	:	718-648-4441
Fax Number	:	718-648-4328

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

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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Directions to “ MARAT BLUSTIN RPH” Practice Location

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