MEDICARE: JULIA VAN PHARMD

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	059558	NY

General Provider Information

NPI Number	:	1568870079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA VAN PHARMD

Provider Business Mailing Address
First Line	:	51 ASTOR PL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-7139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 ASTOR PL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-7139
Country	:	US
Telephone Number	:	212-777-1638
Fax Number	:

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	04/24/2016

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