MEDICARE: MT.VERNON PRESCRIPTION INC.

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	333600000X	Pharmacy	020574	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3396327	OTHER	NY	NABP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578606430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT.VERNON PRESCRIPTION INC.

Provider Business Mailing Address
First Line	:	105 STEVENS AVE
Second Line	:
City	:	MT VERNON
State	:	NY
Zip	:	10550-2686
Country	:	US
Telephone Number	:	914-664-0300
Fax Number	:	914-664-0857

Provider Business Practice Location Address
First Line	:	105 STEVENS AVE
Second Line	:
City	:	MT VERNON
State	:	NY
Zip	:	10550-2686
Country	:	US
Telephone Number	:	914-664-0300
Fax Number	:	914-664-0857

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. GIRISH RASIKLAL PATEL
Credential	:	REG.PHARMACIST
Telephone Number	:	914-664-0300

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	02/02/2012

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