MEDICARE: DR. EDITH TORTORA MICALE PHARM.D

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	28R101158600	NJ

General Provider Information

NPI Number	:	1558698324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDITH TORTORA MICALE PHARM.D

Provider Business Mailing Address
First Line	:	7855 BOULEVARD E
Second Line	:	APARTMENT 7C
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5938
Country	:	US
Telephone Number	:	201-662-0623
Fax Number	:	201-662-0672

Provider Business Practice Location Address
First Line	:	7855 BOULEVARD E
Second Line	:	APARTMENT 7C
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5938
Country	:	US
Telephone Number	:	201-662-0623
Fax Number	:	201-662-0672

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

Provider Enumeration Date	:	11/15/2009
Last Update Date	:	11/15/2009

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