MEDICARE: NESSET PAVILION PHARMACY

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	333600000X	Pharmacy		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14-40469	OTHER		NABP

General Provider Information

NPI Number	:	1760483465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NESSET PAVILION PHARMACY

Provider Business Mailing Address
First Line	:	1775 BALLARD RD
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1005
Country	:	US
Telephone Number	:	847-318-2810
Fax Number	:	847-318-2795

Provider Business Practice Location Address
First Line	:	1775 BALLARD RD
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1005
Country	:	US
Telephone Number	:	847-318-2810
Fax Number	:	847-318-2795

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	LINDA B. GEHRT
Credential	:	RPH
Telephone Number	:	847-318-2810

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	10/23/2007

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Directions to “NESSET PAVILION PHARMACY ” Practice Location

Language	Start Address	Practice Location

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