MEDICARE: MRS. JANIS LEE GARLOCK RPH

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	15356	IA
2	183500000X	Pharmacist		IL

General Provider Information

NPI Number	:	1790756633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANIS LEE GARLOCK RPH

Provider Business Mailing Address
First Line	:	1726 20-1/2 AVENUE
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201
Country	:	US
Telephone Number	:	309-786-8319
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 JOHN DEERE RD
Second Line	:
City	:	MOLINE
State	:	IL
Zip	:	61265-6892
Country	:	US
Telephone Number	:	309-779-5010
Fax Number	:	309-779-5018

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/18/2007

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