MEDICARE: RENE KRUPA 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	051.031047	IL
2	183500000X	Pharmacist	PST.019634	LA

General Provider Information

NPI Number	:	1073865416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE KRUPA RPH

Provider Business Mailing Address
First Line	:	1329 S YALE AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3418
Country	:	US
Telephone Number	:	847-577-6784
Fax Number	:

Provider Business Practice Location Address
First Line	:	1329 S YALE AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3418
Country	:	US
Telephone Number	:	847-577-6784
Fax Number	:

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

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	10/09/2012

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