MEDICARE: JACOB GHOLIAN DR

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	054214-1	NY

General Provider Information

NPI Number	:	1679805949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB GHOLIAN DR

Provider Business Mailing Address
First Line	:	3406 AVENUE P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3441
Country	:	US
Telephone Number	:	347-733-4422
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-2602
Country	:	US
Telephone Number	:	718-272-2504
Fax Number	:

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

Provider Enumeration Date	:	02/11/2010
Last Update Date	:	02/11/2010

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Directions to “ JACOB GHOLIAN DR” Practice Location

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