MEDICARE: MR. DAVID ORELLANA

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	051-040527	IL

General Provider Information

NPI Number	:	1922378611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ORELLANA

Provider Business Mailing Address
First Line	:	9724 S MARQUETTE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-4946
Country	:	US
Telephone Number	:	773-933-9491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 E SAUK TRL
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411-5262
Country	:	US
Telephone Number	:	708-757-6906
Fax Number	:	708-757-7867

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

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/11/2012

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Directions to “ MR. DAVID ORELLANA ” Practice Location

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