MEDICARE: NICHOLAS SASELU RPH

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	026739-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548406226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS SASELU RPH

Provider Business Mailing Address
First Line	:	25 WATERFRONT PL
Second Line	:
City	:	PORTCHESTER
State	:	NY
Zip	:	10583
Country	:	US
Telephone Number	:	914-937-7452
Fax Number	:	914-937-7894

Provider Business Practice Location Address
First Line	:	25 WATERFRONT PL
Second Line	:
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-6001
Country	:	US
Telephone Number	:	914-937-7452
Fax Number	:	914-937-7894

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

Provider Enumeration Date	:	12/30/2008
Last Update Date	:	03/04/2009

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