MEDICARE: MR. OM TANDON RPH

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	038221	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28RI02052200	OTHER	NJ	STATE LICENCE NUMBER
2	038221	OTHER	NY	STATE LICENCE NUMBER

General Provider Information

NPI Number	:	1609045780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OM TANDON RPH

Provider Business Mailing Address
First Line	:	2408 WINDER DR.
Second Line	:
City	:	BRIDGEWATER
State	:	NJ
Zip	:	08807
Country	:	US
Telephone Number	:	718-761-8484
Fax Number	:	718-370-8863

Provider Business Practice Location Address
First Line	:	2875 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5811
Country	:	US
Telephone Number	:	718-761-8484
Fax Number	:	718-370-8863

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

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/22/2008

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Directions to “ MR. OM TANDON RPH” Practice Location

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