MEDICARE: JOLANTA KUDELKO

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	053725	NY

General Provider Information

NPI Number	:	1154644862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLANTA KUDELKO

Provider Business Mailing Address
First Line	:	3191 EMMONS AVE
Second Line	:	APT 4E
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3823 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	718-743-8933
Fax Number	:

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

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	03/09/2010

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