MEDICARE: KAWALDATH SAROOP PHARMACIST

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	038182-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6127228	OTHER	NY	REGISTRATION NUMBER

General Provider Information

NPI Number	:	1215195847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAWALDATH SAROOP PHARMACIST

Provider Business Mailing Address
First Line	:	9716 116TH ST
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1244
Country	:	US
Telephone Number	:	718-846-8099
Fax Number	:

Provider Business Practice Location Address
First Line	:	9716 116TH ST
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1244
Country	:	US
Telephone Number	:	718-846-8099
Fax Number	:

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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