MEDICARE: MR. JERRY STEVE HABER 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	033774	NY

General Provider Information

NPI Number	:	1568794741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERRY STEVE HABER R.PH.

Provider Business Mailing Address
First Line	:	3067 BEDFORD AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210
Country	:	US
Telephone Number	:	718-258-6453
Fax Number	:	718-951-6095

Provider Business Practice Location Address
First Line	:	1630 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4716
Country	:	US
Telephone Number	:	718-258-4200
Fax Number	:	718-951-6095

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

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	02/12/2010

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