MEDICARE: MR. MARIO T PICARELLO 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	35547	NY

General Provider Information

NPI Number	:	1427231067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARIO T PICARELLO RPH

Provider Business Mailing Address
First Line	:	97 LOCKWOOD RD
Second Line	:
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-1066
Country	:	US
Telephone Number	:	914-528-2800
Fax Number	:	914-528-9015

Provider Business Practice Location Address
First Line	:	3145 E MAIN ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1521
Country	:	US
Telephone Number	:	914-525-2800
Fax Number	:	914-528-9015

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

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/05/2007

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