MEDICARE: SANDRA KALVAITIS

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	059800	NY

General Provider Information

NPI Number	:	1437551967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA KALVAITIS

Provider Business Mailing Address
First Line	:	2015 SHORE PKWY APT 10 G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 SHORE PKWY APT 10G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6857
Country	:	US
Telephone Number	:	347-307-4713
Fax Number	:

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

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	09/16/2014

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