MEDICARE: YEVA PISAREVSKY R.PH.

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	045827-1	NY

General Provider Information

NPI Number	:	1538619564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEVA PISAREVSKY R.PH.

Provider Business Mailing Address
First Line	:	2356 61ST ST
Second Line	:	#1A
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2652
Country	:	US
Telephone Number	:	718-614-7468
Fax Number	:

Provider Business Practice Location Address
First Line	:	1416 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2004
Country	:	US
Telephone Number	:	718-375-5757
Fax Number	:

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

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	10/13/2016

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