MEDICARE: MR. RAJ JANAMPALLY

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	050257	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050257	OTHER	NY	STATE LICENSE

General Provider Information

NPI Number	:	1679875611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAJ JANAMPALLY

Provider Business Mailing Address
First Line	:	2702 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-1210
Country	:	US
Telephone Number	:	718-665-1410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-1210
Country	:	US
Telephone Number	:	718-665-1410
Fax Number	:

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

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	11/24/2010

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