MEDICARE: MR. FRANK J DAVERSO JR.

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	18553	NJ

General Provider Information

NPI Number	:	1548439557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANK J DAVERSO JR.

Provider Business Mailing Address
First Line	:	121 W PALMER AVE
Second Line	:
City	:	WEST LONG BRANCH
State	:	NJ
Zip	:	07764-1249
Country	:	US
Telephone Number	:	732-542-6204
Fax Number	:	732-389-7434

Provider Business Practice Location Address
First Line	:	121 W PALMER AVE
Second Line	:
City	:	WEST LONG BRANCH
State	:	NJ
Zip	:	07764-1249
Country	:	US
Telephone Number	:	732-542-6204
Fax Number	:	732-389-7434

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

Provider Enumeration Date	:	02/23/2008
Last Update Date	:	02/23/2008

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