MEDICARE: MRS. CHRISTINA ANN MINERVA 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
1	183500000X	Pharmacist	036735-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036735-1	OTHER	NY	NYS PHARMACIST LICENSE

General Provider Information

NPI Number	:	1306016340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA ANN MINERVA RPH

Provider Business Mailing Address
First Line	:	492 ATLANTIC AVE
Second Line	:
City	:	EAST ROCKAWAY
State	:	NY
Zip	:	11518-1533
Country	:	US
Telephone Number	:	516-599-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	492 ATLANTIC AVE
Second Line	:
City	:	EAST ROCKAWAY
State	:	NY
Zip	:	11518-1517
Country	:	US
Telephone Number	:	516-599-2233
Fax Number	:	516-596-3285

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

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	05/04/2010

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