MEDICARE: JEREMY SCHIPPER R.PH.

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	062484	NY

General Provider Information

NPI Number	:	1902349921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY SCHIPPER R.PH.

Provider Business Mailing Address
First Line	:	4815 VERNON BLVD
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5616
Country	:	US
Telephone Number	:	718-361-7390
Fax Number	:

Provider Business Practice Location Address
First Line	:	4815 VERNON BLVD
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5616
Country	:	US
Telephone Number	:	718-361-7390
Fax Number	:

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

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	11/22/2016

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