MEDICARE: MRS. CHRISTINE MARIA CIOLKO 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		IL

General Provider Information

NPI Number	:	1083832893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE MARIA CIOLKO RPH

Provider Business Mailing Address
First Line	:	1149 HARLAN CT
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-3854
Country	:	US
Telephone Number	:	847-295-2362
Fax Number	:

Provider Business Practice Location Address
First Line	:	1149 HARLAN CT
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-3854
Country	:	US
Telephone Number	:	847-295-2362
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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