MEDICARE: LIGY THADATHIL 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	063583	NY

General Provider Information

NPI Number	:	1730695909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIGY THADATHIL RPH

Provider Business Mailing Address
First Line	:	2237 128TH ST
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 PROSPECT PARK W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5802
Country	:	US
Telephone Number	:	718-768-1325
Fax Number	:

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

Provider Enumeration Date	:	12/23/2017
Last Update Date	:	12/23/2017

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