MEDICARE: ALEXANDRA M VASIC PHARM D.

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	RP442229	PA

General Provider Information

NPI Number	:	1699049759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA M VASIC PHARM D.

Provider Business Mailing Address
First Line	:	207 ROUTE 6 W
Second Line	:
City	:	COUDERSPORT
State	:	PA
Zip	:	16915-8465
Country	:	US
Telephone Number	:	814-274-0439
Fax Number	:	814-274-0439

Provider Business Practice Location Address
First Line	:	207 ROUTE 6 W
Second Line	:
City	:	COUDERSPORT
State	:	PA
Zip	:	16915-8465
Country	:	US
Telephone Number	:	814-274-0439
Fax Number	:	814-274-0439

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

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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Directions to “ ALEXANDRA M VASIC PHARM D.” Practice Location

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