MEDICARE: MRS. MARIE HENNESSY KERWIN 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	032997-1	NY

General Provider Information

NPI Number	:	1932277639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE HENNESSY KERWIN RPH

Provider Business Mailing Address
First Line	:	7550 SISSON HWY
Second Line	:
City	:	EDEN
State	:	NY
Zip	:	14057
Country	:	US
Telephone Number	:	716-648-7402
Fax Number	:

Provider Business Practice Location Address
First Line	:	AVERYS PHARMACY DBA N COLLINS PHARMACY 10504 MAIN ST
Second Line	:
City	:	NORTH COLLINS
State	:	NY
Zip	:	14111
Country	:	US
Telephone Number	:	716-337-2992
Fax Number	:	716-337-3090

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/08/2007

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