MEDICARE: DR. VIVEK NAVANEETHAN M.S., PHARM. D.

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	28RI02831300	NJ
2	183500000X	Pharmacist	14402	MD
3	183500000X	Pharmacist	RP437415	PA
4	183500000X	Pharmacist	A10003261	DE

General Provider Information

NPI Number	:	1285636761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVEK NAVANEETHAN M.S., PHARM. D.

Provider Business Mailing Address
First Line	:	8 BRIDLE PATH CT
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-5645
Country	:	US
Telephone Number	:	856-629-7807
Fax Number	:	856-629-7807

Provider Business Practice Location Address
First Line	:	8 BRIDLE PATH CT
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-5645
Country	:	US
Telephone Number	:	856-629-7807
Fax Number	:	856-629-7807

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

Provider Enumeration Date	:	08/13/2005
Last Update Date	:	07/08/2007

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