MEDICARE: DR. JACQUELINE BARDINI

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	039405	NY
2	183500000X	Pharmacist	PCT.0008917	CT

General Provider Information

NPI Number	:	1649593575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE BARDINI

Provider Business Mailing Address
First Line	:	18 FAIRWAYS LN
Second Line	:
City	:	BEACON
State	:	NY
Zip	:	12508-7018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 E MAIN ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1356
Country	:	US
Telephone Number	:	914-528-5159
Fax Number	:

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

Provider Enumeration Date	:	03/06/2010
Last Update Date	:	03/06/2010

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