MEDICARE: MR. GARY DAVID FRECHTER 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	13869	NY
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	13869	NY

General Provider Information

NPI Number	:	1972779981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY DAVID FRECHTER PHARMACIST

Provider Business Mailing Address
First Line	:	659 ARBUCKLE AVE
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-2701
Country	:	US
Telephone Number	:	516-295-3181
Fax Number	:	516-295-5839

Provider Business Practice Location Address
First Line	:	3199 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-4107
Country	:	US
Telephone Number	:	516-766-7200
Fax Number	:	516-763-1426

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

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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