MEDICARE: MR. MARK S SMALEC JD

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	033564-1	NY

General Provider Information

NPI Number	:	1184959074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK S SMALEC JD

Provider Business Mailing Address
First Line	:	PO BOX 432
Second Line	:
City	:	DOVER PLAINS
State	:	NY
Zip	:	12522
Country	:	US
Telephone Number	:	845-877-6372
Fax Number	:	845-877-6524

Provider Business Practice Location Address
First Line	:	3184 ROUTE 22
Second Line	:
City	:	DOVER PLAINS
State	:	NY
Zip	:	12522-5924
Country	:	US
Telephone Number	:	845-877-6372
Fax Number	:	845-877-6524

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

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	10/09/2009

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