MEDICARE: MRS. JILL MARIE DRURY PHARM.D.

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051292434	IL
2	1835X0200X	Oncology Pharmacist	14884-40	WI

General Provider Information

NPI Number	:	1023382520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL MARIE DRURY PHARM.D.

Provider Business Mailing Address
First Line	:	474 N LAKE SHORE DR
Second Line	:	SUITE 3407
City	:	CHICAGO
State	:	IL
Zip	:	60611-3400
Country	:	US
Telephone Number	:	312-618-7465
Fax Number	:	952-352-6682

Provider Business Practice Location Address
First Line	:	474 N LAKE SHORE DR
Second Line	:	SUITE 3407
City	:	CHICAGO
State	:	IL
Zip	:	60611-3400
Country	:	US
Telephone Number	:	312-618-7465
Fax Number	:	952-352-6682

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

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	02/29/2012

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