MEDICARE: PAUL BELCHAK

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	051.294949	IL

General Provider Information

NPI Number	:	1699370650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BELCHAK

Provider Business Mailing Address
First Line	:	1819 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-3716
Country	:	US
Telephone Number	:	773-237-8927
Fax Number	:	773-237-9037

Provider Business Practice Location Address
First Line	:	1819 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-3716
Country	:	US
Telephone Number	:	773-237-8927
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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