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NPI Code Detail

MEDICARE: MR. ROBERT F. PETSCHE RPH.

MEDICARE: MR. ROBERT F. PETSCHE RPH.
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
1183500000XPharmacist044636NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1044636OTHERNYPHARMACY LICENSCE #

General Provider Information

NPI Number : 1295904746
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT F. PETSCHE RPH.
Provider Business Mailing Address
First Line : 6918 62ND DR
Second Line :
City : MIDDLE VILLAGE
State : NY
Zip : 11379-1102
Country : US
Telephone Number : 718-326-2804
Fax Number :
Provider Business Practice Location Address
First Line : 9210 ATLANTIC AVE
Second Line :
City : OZONE PARK
State : NY
Zip : 11416-1517
Country : US
Telephone Number : 718-835-7903
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2008
Last Update Date : 02/28/2008

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