MEDICARE: MR. JOHN MICHAEL EREMITA 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	042191	NY

General Provider Information

NPI Number	:	1922244029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MICHAEL EREMITA RPH

Provider Business Mailing Address
First Line	:	91 FAIRVIEW AVE
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-1317
Country	:	US
Telephone Number	:	973-239-1631
Fax Number	:	212-694-5290

Provider Business Practice Location Address
First Line	:	3340 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-7401
Country	:	US
Telephone Number	:	212-281-1270
Fax Number	:	212-694-5290

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

Provider Enumeration Date	:	12/20/2008
Last Update Date	:	12/20/2008

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