MEDICARE: EVELYN FANG

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	051289638	IL

General Provider Information

NPI Number	:	1215486816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN FANG

Provider Business Mailing Address
First Line	:	3251 S NORMAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3511
Country	:	US
Telephone Number	:	312-933-6366
Fax Number	:

Provider Business Practice Location Address
First Line	:	3251 S NORMAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3511
Country	:	US
Telephone Number	:	312-933-6366
Fax Number	:

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

Provider Enumeration Date	:	09/25/2016
Last Update Date	:	09/25/2016

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Directions to “ EVELYN FANG ” Practice Location

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