MEDICARE: JOHN UTELL 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	027777	NY

General Provider Information

NPI Number	:	1730189705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN UTELL RPH

Provider Business Mailing Address
First Line	:	5 MEYER LN
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-4116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 SUNRISE HWY
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-4625
Country	:	US
Telephone Number	:	631-567-3215
Fax Number	:

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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