MEDICARE: TERESA ANN HAZIRJIAN

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	054975	NY

General Provider Information

NPI Number	:	1609183276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ANN HAZIRJIAN

Provider Business Mailing Address
First Line	:	2084 STATE ROUTE 208
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-2611
Country	:	US
Telephone Number	:	845-987-6515
Fax Number	:

Provider Business Practice Location Address
First Line	:	2084 STATE ROUTE 208
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-2611
Country	:	US
Telephone Number	:	845-987-6515
Fax Number	:

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

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	08/27/2012

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