MEDICARE: RAYMOND J SAVASTIO 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	051-034511	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033490057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND J SAVASTIO RPH

Provider Business Mailing Address
First Line	:	1723 WOODLAND AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4343 N KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1301
Country	:	US
Telephone Number	:	773-604-4419
Fax Number	:

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

Provider Enumeration Date	:	09/03/2011
Last Update Date	:	09/03/2011

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