MEDICARE: DR. TERRA LAINE WHITLOW PHARM.D.

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	051.301859	IL
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051.301859	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051.301859	OTHER	IL	ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

General Provider Information

NPI Number	:	1861951253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRA LAINE WHITLOW PHARM.D.

Provider Business Mailing Address
First Line	:	5201 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2512
Country	:	US
Telephone Number	:	773-506-0910
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2512
Country	:	US
Telephone Number	:	773-506-0910
Fax Number	:

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

Provider Enumeration Date	:	03/15/2019
Last Update Date	:	01/19/2020

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