MEDICARE: MRS. CAROL O MUZZARELLI PHARMACIST

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	051027295	IL

General Provider Information

NPI Number	:	1497077184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL O MUZZARELLI PHARMACIST

Provider Business Mailing Address
First Line	:	208 EMILIE ST
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-1949
Country	:	US
Telephone Number	:	618-344-5903
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 BELT LINE RD
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-4368
Country	:	US
Telephone Number	:	618-346-8883
Fax Number	:

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

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	02/22/2010

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