MEDICARE: MISS RAAKHEE NAGESH SHIRSAT RPH, CDM

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	046313	NY

General Provider Information

NPI Number	:	1629102991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RAAKHEE NAGESH SHIRSAT RPH, CDM

Provider Business Mailing Address
First Line	:	8 MALLARD PATH
Second Line	:
City	:	CORAM
State	:	NY
Zip	:	11727-2154
Country	:	US
Telephone Number	:	631-928-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	593 OLD TOWN RD
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-4244
Country	:	US
Telephone Number	:	631-473-4907
Fax Number	:	631-473-6530

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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