MEDICARE: DARIA F YUSCHAK R.PH.

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	7871	CT

General Provider Information

NPI Number	:	1336368463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIA F YUSCHAK R.PH.

Provider Business Mailing Address
First Line	:	141 CODFISH HILL RD
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-3203
Country	:	US
Telephone Number	:	203-744-3768
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 GREENWOOD AVE
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2530
Country	:	US
Telephone Number	:	203-744-0945
Fax Number	:	203-790-4169

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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