MEDICARE: DOMINICK M. LETTIERI

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	037436	NY

General Provider Information

NPI Number	:	1477885473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINICK M. LETTIERI

Provider Business Mailing Address
First Line	:	4914 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3418
Country	:	US
Telephone Number	:	718-633-4900
Fax Number	:	718-435-0324

Provider Business Practice Location Address
First Line	:	4914 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3418
Country	:	US
Telephone Number	:	718-633-4900
Fax Number	:	718-435-0324

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

Provider Enumeration Date	:	02/02/2010
Last Update Date	:	02/02/2010

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