MEDICARE: MARY DILEONARDO GREVE

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	049357	NY

General Provider Information

NPI Number	:	1215253398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY DILEONARDO GREVE

Provider Business Mailing Address
First Line	:	PO BOX 1000
Second Line	:	MS3000
City	:	PORTLAND
State	:	ME
Zip	:	04104-5005
Country	:	US
Telephone Number	:	207-885-7454
Fax Number	:	207-396-2028

Provider Business Practice Location Address
First Line	:	3650 ROUTE 9W
Second Line	:
City	:	HIGHLAND
State	:	NY
Zip	:	12528-2033
Country	:	US
Telephone Number	:	845-691-9155
Fax Number	:	845-691-2749

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

Provider Enumeration Date	:	04/14/2010
Last Update Date	:	04/14/2010

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Directions to “ MARY DILEONARDO GREVE ” Practice Location

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