MEDICARE: HUGUENOT PHARMACY

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	28026	NY

General Provider Information

NPI Number	:	1467697623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUGUENOT PHARMACY

Provider Business Mailing Address
First Line	:	877 HUGUENOT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3920
Country	:	US
Telephone Number	:	718-605-4158
Fax Number	:

Provider Business Practice Location Address
First Line	:	877 HUGUENOT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3920
Country	:	US
Telephone Number	:	718-605-4158
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED PHARMACIST
Name	:	MR. CONRAD JOSEPH SIDOTI
Credential	:
Telephone Number	:	718-984-0477

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/02/2008

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