MEDICARE: MR. THOMAS JOSEPH OLERTA JR.

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	14449	MD
2	183500000X	Pharmacist	RP042267L	PA

General Provider Information

NPI Number	:	1790082816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS JOSEPH OLERTA JR.

Provider Business Mailing Address
First Line	:	9420 LAKE VIEW DR
Second Line	:
City	:	BERLIN
State	:	MD
Zip	:	21811-2731
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10119 OLD OCEAN CITY BLVD
Second Line	:
City	:	BERLIN
State	:	MD
Zip	:	21811-1143
Country	:	US
Telephone Number	:	410-629-0537
Fax Number	:	410-629-0554

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

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	02/25/2011

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