MEDICARE: ALEX KOWALSKI PHARM,D.

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	051.293601	IL

General Provider Information

NPI Number	:	1023496742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX KOWALSKI PHARM,D.

Provider Business Mailing Address
First Line	:	2641 N. SPRINGFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2641 N SPRINGFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1030
Country	:	US
Telephone Number	:	847-212-8297
Fax Number	:

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

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	05/14/2015

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