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NPI Code Detail

MEDICARE: MR. JACOB R KALATHIVEETIL BS IN PHARMACY

MEDICARE: MR. JACOB R KALATHIVEETIL BS IN PHARMACY
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
1183500000XPharmacist051030494IL

General Provider Information

NPI Number : 1962783621
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACOB R KALATHIVEETIL BS IN PHARMACY
Provider Business Mailing Address
First Line : 1926 W 35TH ST
Second Line : WALGREENS
City : CHICAGO
State : IL
Zip : 60609-1204
Country : US
Telephone Number : 773-254-5523
Fax Number : 773-254-9537
Provider Business Practice Location Address
First Line : 1926 W 35TH ST
Second Line : WALGREENS
City : CHICAGO
State : IL
Zip : 60609-1204
Country : US
Telephone Number : 773-254-5523
Fax Number : 773-254-9537
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2011
Last Update Date : 09/07/2011

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