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NPI Code Detail

MEDICARE: JEFFREY MA PHARMD

MEDICARE: JEFFREY MA PHARMD
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
1183500000XPharmacist051287363IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861774390
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY MA PHARMD
Provider Business Mailing Address
First Line : 4830 GRAND AVE
Second Line :
City : GURNEE
State : IL
Zip : 60031-2618
Country : US
Telephone Number : 847-662-2585
Fax Number :
Provider Business Practice Location Address
First Line : 4830 GRAND AVE
Second Line :
City : GURNEE
State : IL
Zip : 60031-2618
Country : US
Telephone Number : 847-662-2585
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2011
Last Update Date : 09/11/2011

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Directions to “ JEFFREY MA PHARMD” Practice Location

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