MEDICARE: MRS. DELORES DIANE FRIEDRICH RPH

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
1	183500000X	Pharmacist	051041194	IL

General Provider Information

NPI Number	:	1013028885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DELORES DIANE FRIEDRICH RPH

Provider Business Mailing Address
First Line	:	4104 FIELDING DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-4004
Country	:	US
Telephone Number	:	217-483-7431
Fax Number	:	217-483-7491

Provider Business Practice Location Address
First Line	:	1053 JASON PL
Second Line	:
City	:	CHATHAM
State	:	IL
Zip	:	62629-2018
Country	:	US
Telephone Number	:	217-483-7431
Fax Number	:	217-483-7491

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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