=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114927423
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN PARISE PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2005
-----------------------------------------------------
Last Update Date | 07/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16170 KINGSPORT RD
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60467-5602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-259-4719
-----------------------------------------------------
Fax | 708-349-9792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16170 KINGSPORT RD
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60467-5602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-259-4719
-----------------------------------------------------
Fax | 708-349-9792
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | 051034213
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 051034213
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 224L00000X
-----------------------------------------------------
Taxonomy Name | Pedorthist
-----------------------------------------------------
License Number | 212000160
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------