MEDICARE: MRS. LUDMILA NICKOLAIVNA TKACH SP 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	045758	NY

General Provider Information

NPI Number	:	1982886370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LUDMILA NICKOLAIVNA TKACH SP RPH

Provider Business Mailing Address
First Line	:	931 1ST AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-8031
Country	:	US
Telephone Number	:	212-421-1046
Fax Number	:	212-838-6610

Provider Business Practice Location Address
First Line	:	931 1ST AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-8031
Country	:	US
Telephone Number	:	212-421-1046
Fax Number	:	212-838-6610

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

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	11/28/2007

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