MEDICARE: MARINA VAYSBAUM 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	046665	NY

General Provider Information

NPI Number	:	1972521821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA VAYSBAUM RPH

Provider Business Mailing Address
First Line	:	830 DAVIS AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-3133
Country	:	US
Telephone Number	:	718-309-8936
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5558
Country	:	US
Telephone Number	:	718-891-2801
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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Directions to “ MARINA VAYSBAUM RPH” Practice Location

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