MEDICARE: BRIAN OVER

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	051040331	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	249156	OTHER	IL	NCPDP

General Provider Information

NPI Number	:	1093181182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN OVER

Provider Business Mailing Address
First Line	:	196 AMHERST CIR # IR
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-5200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 SPALDING DR STE 101
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6551
Country	:	US
Telephone Number	:	630-527-5204
Fax Number	:

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

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	08/12/2015

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Directions to “ BRIAN OVER ” Practice Location

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