MEDICARE: PETER W MAYO RPH

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	040147	NY

General Provider Information

NPI Number	:	1689906083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER W MAYO RPH

Provider Business Mailing Address
First Line	:	66-87 FRESH POND ROAD
Second Line	:	MIL-RUE CHEMISTS, INC.
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-3948
Country	:	US
Telephone Number	:	718-821-3271
Fax Number	:	718-386-9777

Provider Business Practice Location Address
First Line	:	66-87 FRESH POND ROAD
Second Line	:	MIL-RUE CHEMISTS, INC.
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-3948
Country	:	US
Telephone Number	:	718-821-3271
Fax Number	:	718-386-9777

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

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	02/10/2010

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