MEDICARE: ANTONIA MARY RYDZYK 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	28340	NY

General Provider Information

NPI Number	:	1801075320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIA MARY RYDZYK RPH

Provider Business Mailing Address
First Line	:	9062 ERIE RD
Second Line	:
City	:	ANGOLA
State	:	NY
Zip	:	14006-8824
Country	:	US
Telephone Number	:	716-549-2701
Fax Number	:	716-549-8444

Provider Business Practice Location Address
First Line	:	9062 ERIE RD
Second Line	:
City	:	ANGOLA
State	:	NY
Zip	:	14006-8824
Country	:	US
Telephone Number	:	716-549-2701
Fax Number	:	716-549-8444

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	10/31/2007

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