MEDICARE: LISA GELFAND

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	055737	NY

General Provider Information

NPI Number	:	1629357421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA GELFAND

Provider Business Mailing Address
First Line	:	458 NEPTUNE AVE
Second Line	:	APT. 3H
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1942 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3135
Country	:	US
Telephone Number	:	718-234-2500
Fax Number	:

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

Provider Enumeration Date	:	08/10/2011
Last Update Date	:	08/10/2011

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