MEDICARE: MR. MARC ALTSCHULD

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	029792	NY

General Provider Information

NPI Number	:	1841723970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARC ALTSCHULD

Provider Business Mailing Address
First Line	:	45 KENNEDY DR
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-5319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 KENNEDY DR
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-5319
Country	:	US
Telephone Number	:	845-414-9966
Fax Number	:

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/05/2017

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