MEDICARE: ROBERTO DESIRAL

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	460186119	NY

General Provider Information

NPI Number	:	1740521590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO DESIRAL

Provider Business Mailing Address
First Line	:	5008 AVENUE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5906
Country	:	US
Telephone Number	:	718-576-6950
Fax Number	:	718-576-6955

Provider Business Practice Location Address
First Line	:	5008 AVENUE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5906
Country	:	US
Telephone Number	:	718-576-6950
Fax Number	:	718-576-6955

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

Provider Enumeration Date	:	03/04/2013
Last Update Date	:	03/04/2013

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Directions to “ ROBERTO DESIRAL ” Practice Location

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