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General NPI Number Information
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NPI Number | 1013390202
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Entity Type | Individual
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Provider Name | EVERARDO JESUS MOJICA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 6525 W DIVERSEY AVE
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City | CHICAGO
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State | IL
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Zip | 60707-2312
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Country | US
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Telephone | 773-804-3611
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Fax |
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Provider Business Mailing Address
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Address Line | 3722 W GIDDINGS ST
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City | CHICAGO
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State | IL
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Zip | 60625-5739
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Country | US
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Telephone | 773-715-0919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 049.201057
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License Number State | IL
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