MEDICARE: MRS. MIRA LEVIN PHARMACIST

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	044359	NY

General Provider Information

NPI Number	:	1497079826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRA LEVIN PHARMACIST

Provider Business Mailing Address
First Line	:	2617 E 17TH ST # U7E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3825
Country	:	US
Telephone Number	:	646-683-7183
Fax Number	:	718-897-2570

Provider Business Practice Location Address
First Line	:	2617 E 17TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3825
Country	:	US
Telephone Number	:	646-683-7183
Fax Number	:	718-897-2570

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

Provider Enumeration Date	:	03/14/2010
Last Update Date	:	03/14/2010

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