MEDICARE: DR. MARY M. AZIZ PHARM. D.

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	28RI03376800	NJ

General Provider Information

NPI Number	:	1427331214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY M. AZIZ PHARM. D.

Provider Business Mailing Address
First Line	:	177 TONTINE AVE
Second Line	:
City	:	LYNDHURST
State	:	NJ
Zip	:	07071-1816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1637 YORK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-6545
Country	:	US
Telephone Number	:	212-534-2000
Fax Number	:

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

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	06/07/2013

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