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NPI Code Detail

MEDICARE: PATRICIA AVALOS

MEDICARE: PATRICIA AVALOS
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
1183500000XPharmacist051298856IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A14268082679OTHERILDRIVER'S LICENSE

General Provider Information

NPI Number : 1114530763
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA AVALOS
Provider Business Mailing Address
First Line : 9226 KELLY CT
Second Line :
City : ORLAND HILLS
State : IL
Zip : 60487-4692
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2345 W 103RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60643-2423
Country : US
Telephone Number : 773-429-0767
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2020
Last Update Date : 08/24/2020

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Directions to “ PATRICIA AVALOS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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