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NPI Code Detail

MEDICARE: MR. THOMAS E. GRUDOWSKI RPH

MEDICARE: MR. THOMAS E. GRUDOWSKI 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
1183500000XPharmacistIL

General Provider Information

NPI Number : 1063577963
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS E. GRUDOWSKI RPH
Provider Business Mailing Address
First Line : 4254 W 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4642
Country : US
Telephone Number : 773-582-2660
Fax Number : 773-767-3022
Provider Business Practice Location Address
First Line : 4254 W 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4642
Country : US
Telephone Number : 773-582-2660
Fax Number : 773-767-3022
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2006
Last Update Date : 07/08/2007

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