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NPI Code Detail

MEDICARE: MAUREEN CAPULONG PHARMD

MEDICARE: MAUREEN CAPULONG 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
1183500000XPharmacist051.292923IL

General Provider Information

NPI Number : 1942581327
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAUREEN CAPULONG PHARMD
Provider Business Mailing Address
First Line : 1530 N ORLEANS ST
Second Line : 2ND FLOOR
City : CHICAGO
State : IL
Zip : 60610-1221
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3110 W ARMITAGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-3819
Country : US
Telephone Number : 773-235-6758
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2011
Last Update Date : 08/30/2011

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