MEDICARE: MRS. MARIANNA RAKOVITSKY 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	1835P1200X	Pharmacotherapy Pharmacist	044084-1	NY
2	183500000X	Pharmacist	044084-1	NY

General Provider Information

NPI Number	:	1427051986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIANNA RAKOVITSKY RPH

Provider Business Mailing Address
First Line	:	51 HERON DR
Second Line	:
City	:	MARLBORO
State	:	NJ
Zip	:	07746-1903
Country	:	US
Telephone Number	:	732-677-3615
Fax Number	:	732-677-3615

Provider Business Practice Location Address
First Line	:	4352 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4915
Country	:	US
Telephone Number	:	718-891-6363
Fax Number	:	718-891-6363

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	01/14/2010

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