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NPI Code Detail

MEDICARE: DR. LONNIE GIVENS

MEDICARE: DR. LONNIE GIVENS
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
1183500000XPharmacist051-289643IL

General Provider Information

NPI Number : 1073888350
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LONNIE GIVENS
Provider Business Mailing Address
First Line : 175 W ARMY TRAIL RD
Second Line : T-0865
City : GLENDALE HEIGHTS
State : IL
Zip : 60139-1971
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 175 W ARMY TRAIL RD
Second Line :
City : GLENDALE HEIGHTS
State : IL
Zip : 60139-1971
Country : US
Telephone Number : 630-582-0065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2012
Last Update Date : 03/20/2012

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