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NPI Code Detail

MEDICARE: TEXAS JACK MONROE PHARMACIST

MEDICARE: TEXAS JACK MONROE PHARMACIST
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
1183500000XPharmacist051-030542IL

General Provider Information

NPI Number : 1912278979
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEXAS JACK MONROE PHARMACIST
Provider Business Mailing Address
First Line : 40755 N KILBOURNE RD
Second Line :
City : WADSWORTH
State : IL
Zip : 60083-9749
Country : US
Telephone Number : 847-662-7356
Fax Number :
Provider Business Practice Location Address
First Line : 1160 W LAKE COOK RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-1979
Country : US
Telephone Number : 847-537-4074
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2012
Last Update Date : 01/23/2012

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Directions to “ TEXAS JACK MONROE PHARMACIST” Practice Location

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