MEDICARE: MR. CARLO OLIVERI 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	032666	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	032666	OTHER	NY	RPH STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1821266040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLO OLIVERI RPH

Provider Business Mailing Address
First Line	:	2 GRENVILLE CT
Second Line	:
City	:	EAST ROCKAWAY
State	:	NY
Zip	:	11518-1004
Country	:	US
Telephone Number	:	516-599-3248
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 FRONT ST
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-2241
Country	:	US
Telephone Number	:	516-483-3256
Fax Number	:

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

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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