MEDICARE: MR. JOHN RALPH VELK R.PH.

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	:	1093853087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN RALPH VELK R.PH.

Provider Business Mailing Address
First Line	:	133 W SCHOOL ST
Second Line	:
City	:	VILLA PARK
State	:	IL
Zip	:	60181-2543
Country	:	US
Telephone Number	:	630-530-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 E NORTH AVE
Second Line	:	TARGET 957 PHARMACY
City	:	VILLA PARK
State	:	IL
Zip	:	60181-2543
Country	:	US
Telephone Number	:	630-833-7461
Fax Number	:	630-833-7461

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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