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NPI Code Detail

MEDICARE: ECOLA JACKSON CPHT

MEDICARE: ECOLA JACKSON CPHT
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
1183700000XPharmacy Technician049.166756IL

General Provider Information

NPI Number : 1487094942
Entity Type Code : Individual
Provider Name (Legal Business Name) : ECOLA JACKSON CPHT
Provider Business Mailing Address
First Line : 5525 S PULASKI RD
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4400
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5525 S PULASKI RD
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4400
Country : US
Telephone Number : 773-432-0100
Fax Number : 773-432-0101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2013
Last Update Date : 06/28/2013

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Directions to “ ECOLA JACKSON CPHT” Practice Location

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