MEDICARE: MR. PAUL J GREW 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	046222	NY

General Provider Information

NPI Number	:	1760663801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL J GREW RPH

Provider Business Mailing Address
First Line	:	6725 CORTLAND DR
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-9651
Country	:	US
Telephone Number	:	585-820-1344
Fax Number	:	716-631-2961

Provider Business Practice Location Address
First Line	:	6725 CORTLAND DR
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-9651
Country	:	US
Telephone Number	:	585-820-1344
Fax Number	:	716-631-2961

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

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	11/16/2007

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