MEDICARE: VADUZ PHARMACEUTICALLS INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	019356	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3390351	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1730278425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VADUZ PHARMACEUTICALLS INC

Provider Business Mailing Address
First Line	:	7407 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5614
Country	:	US
Telephone Number	:	718-331-5330
Fax Number	:	718-331-3779

Provider Business Practice Location Address
First Line	:	7407 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5614
Country	:	US
Telephone Number	:	718-331-5330
Fax Number	:	718-331-3779

Authorized Official
Title or Position	:	PRESIDENT SUPERVSNG PHARMACIST
Name	:	BART MANNINO
Credential	:
Telephone Number	:	718-331-5330

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/30/2012

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