MEDICARE: DR. MARY CORSO 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	051296333	IL

General Provider Information

NPI Number	:	1417291584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY CORSO PHARM. D.

Provider Business Mailing Address
First Line	:	1036 N DEARBORN ST
Second Line	:	APT 806
City	:	CHICAGO
State	:	IL
Zip	:	60610-3127
Country	:	US
Telephone Number	:	312-613-6090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 N DEARBORN ST
Second Line	:	APT 806
City	:	CHICAGO
State	:	IL
Zip	:	60610-3127
Country	:	US
Telephone Number	:	312-613-6090
Fax Number	:

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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