MEDICARE: LAURA DINEEN PHARMACIST

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	I0596821	NY

General Provider Information

NPI Number	:	1871959478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA DINEEN PHARMACIST

Provider Business Mailing Address
First Line	:	389 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-4101
Country	:	US
Telephone Number	:	917-202-2873
Fax Number	:

Provider Business Practice Location Address
First Line	:	1630 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4716
Country	:	US
Telephone Number	:	718-258-4200
Fax Number	:

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

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	01/12/2016

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