MEDICARE: JENNIFER FISHMAN

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	051291369	IL

General Provider Information

NPI Number	:	1699124701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER FISHMAN

Provider Business Mailing Address
First Line	:	3004 KIRCHOFF RD
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-1818
Country	:	US
Telephone Number	:	847-818-0095
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 KIRCHOFF RD
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-1818
Country	:	US
Telephone Number	:	847-818-0095
Fax Number	:

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

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	06/09/2016

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Directions to “ JENNIFER FISHMAN ” Practice Location

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