MEDICARE: MR. JEROME TOOD GUERRA R.PH.

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		IL

General Provider Information

NPI Number	:	1225019144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEROME TOOD GUERRA R.PH.

Provider Business Mailing Address
First Line	:	3308 N SPRINGFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5112
Country	:	US
Telephone Number	:	773-463-2807
Fax Number	:	773-463-2831

Provider Business Practice Location Address
First Line	:	2807 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-5419
Country	:	US
Telephone Number	:	773-283-8150
Fax Number	:	773-283-3174

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/08/2007

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