MEDICARE: MR. JOHN HENRY ALESSANDRI 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	041119	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041119	OTHER	NY	NYS LICENSE NUMBER

General Provider Information

NPI Number	:	1194057992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN HENRY ALESSANDRI RPH

Provider Business Mailing Address
First Line	:	167 WYCKOFF AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4303
Country	:	US
Telephone Number	:	718-497-3104
Fax Number	:	718-456-5141

Provider Business Practice Location Address
First Line	:	167 WYCKOFF AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4303
Country	:	US
Telephone Number	:	718-497-3104
Fax Number	:	718-456-5141

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

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	02/03/2010

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