MEDICARE: DAVID ASENCIO

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	039116	NY

General Provider Information

NPI Number	:	1285863951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ASENCIO

Provider Business Mailing Address
First Line	:	154 E 174TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-6904
Country	:	US
Telephone Number	:	718-299-2416
Fax Number	:	718-299-5176

Provider Business Practice Location Address
First Line	:	154 E 174TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-6904
Country	:	US
Telephone Number	:	718-299-2416
Fax Number	:	718-299-5176

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

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/02/2009

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Directions to “ DAVID ASENCIO ” Practice Location

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