MEDICARE: MR. PAUL T ANAST RPH

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	051.029130	IL

General Provider Information

NPI Number	:	1396026159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL T ANAST RPH

Provider Business Mailing Address
First Line	:	4704 STIRRUP CUP CT
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-5302
Country	:	US
Telephone Number	:	815-885-9060
Fax Number	:

Provider Business Practice Location Address
First Line	:	4704 STIRRUP CUP CT
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-5302
Country	:	US
Telephone Number	:	815-885-9060
Fax Number	:

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

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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