MEDICARE: AMY S HOGAN

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	183700000X	Pharmacy Technician		IL

General Provider Information

NPI Number	:	1528105111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY S HOGAN

Provider Business Mailing Address
First Line	:	41408 N GREEN BAY RD
Second Line	:
City	:	WADSWORTH
State	:	IL
Zip	:	60083-9481
Country	:	US
Telephone Number	:	847-872-5427
Fax Number	:	847-872-9645

Provider Business Practice Location Address
First Line	:	41408 N GREEN BAY RD
Second Line	:
City	:	WADSWORTH
State	:	IL
Zip	:	60083-9481
Country	:	US
Telephone Number	:	847-872-5427
Fax Number	:	847-872-9645

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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