=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083982151
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JIM TU PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2011
-----------------------------------------------------
Last Update Date | 12/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 W CHICAGO AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60654-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-280-1599
-----------------------------------------------------
Fax | 312-280-2808
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 W CHICAGO AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60654-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-280-1599
-----------------------------------------------------
Fax | 312-280-2808
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051286242
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------