MEDICARE: LORI LYNN PECK PHARM.D.

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	:	1366627101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI LYNN PECK PHARM.D.

Provider Business Mailing Address
First Line	:	3025 E NEW YORK ST
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-5166
Country	:	US
Telephone Number	:	630-236-0847
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 E NEW YORK ST
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-5166
Country	:	US
Telephone Number	:	630-236-0847
Fax Number	:

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

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	12/28/2007

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