MEDICARE: SANDRA MATHELIER

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	043628	NY

General Provider Information

NPI Number	:	1821692302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MATHELIER

Provider Business Mailing Address
First Line	:	21802 99TH AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1206
Country	:	US
Telephone Number	:	516-288-4746
Fax Number	:

Provider Business Practice Location Address
First Line	:	KEY CARE PHARMACY INC
Second Line	:	3411 CHURCH AVE
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:	718-693-1957
Fax Number	:	718-693-0150

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

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	11/25/2020

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