MEDICARE: LISA C MONDIE R.PH.

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		IL

General Provider Information

NPI Number	:	1952306151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA C MONDIE R.PH.

Provider Business Mailing Address
First Line	:	7774 S KARLOV AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-1225
Country	:	US
Telephone Number	:	773-582-9789
Fax Number	:

Provider Business Practice Location Address
First Line	:	7845 S COTTAGE GROVE AVE
Second Line	:	SUITE 100
City	:	CHICAGO
State	:	IL
Zip	:	60619-3100
Country	:	US
Telephone Number	:	773-873-4400
Fax Number	:	773-873-5635

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	08/14/2007

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