=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598042129
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. VALENCIA COMPTON-BAUSWELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2011
-----------------------------------------------------
Last Update Date | 11/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8628 S COTTAGE GROVE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60619-6108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-651-8500
-----------------------------------------------------
Fax | 773-874-0173
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8603 S KINGSTON AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60617-2440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-655-6796
-----------------------------------------------------
Fax | 773-874-0173
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051.290760
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 40973
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------