MEDICARE: MR. JULIUS E BLIACH 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	28RI01902600	NJ
2	183500000X	Pharmacist	037355-1	NY

General Provider Information

NPI Number	:	1366446387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JULIUS E BLIACH RPH

Provider Business Mailing Address
First Line	:	4 ENDICOTT LN
Second Line	:
City	:	WEST WINDSOR
State	:	NJ
Zip	:	08550-2910
Country	:	US
Telephone Number	:	609-799-2924
Fax Number	:	201-866-8254

Provider Business Practice Location Address
First Line	:	5222 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-5524
Country	:	US
Telephone Number	:	609-799-2924
Fax Number	:	201-866-8254

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2007

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