MEDICARE: TAS PHARMACY INC

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	333600000X	Pharmacy	032054	NY

General Provider Information

NPI Number	:	1265864912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAS PHARMACY INC

Provider Business Mailing Address
First Line	:	445 NORTH ST ROUTE 17 M
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-0000
Country	:	US
Telephone Number	:	845-344-4050
Fax Number	:	845-344-4402

Provider Business Practice Location Address
First Line	:	445 NORTH ST ROUTE 17 M
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-0000
Country	:	US
Telephone Number	:	845-344-4050
Fax Number	:	845-344-4402

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MUHAMMAD S RAHMAN
Credential	:
Telephone Number	:	845-800-5453

Provider Enumeration Date	:	08/05/2013
Last Update Date	:	08/05/2013

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