MEDICARE: RENEE CANIK

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	051.291338	IL

General Provider Information

NPI Number	:	1871941328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE CANIK

Provider Business Mailing Address
First Line	:	1500 W MONROE ST UNIT 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1128 CHICAGO AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-1351
Country	:	US
Telephone Number	:	708-707-2278
Fax Number	:

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

Provider Enumeration Date	:	05/25/2016
Last Update Date	:	05/25/2016

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Directions to “ RENEE CANIK ” Practice Location

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