MEDICARE: DR. JIMMY C LIANG PHARMD

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	051293799	IL

General Provider Information

NPI Number	:	1114204617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMY C LIANG PHARMD

Provider Business Mailing Address
First Line	:	360 E SOUTH WATER ST
Second Line	:	#3502
City	:	CHICAGO
State	:	IL
Zip	:	60601-4028
Country	:	US
Telephone Number	:	469-569-2755
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 S M L KING DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4108
Country	:	US
Telephone Number	:	312-326-4058
Fax Number	:

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

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	11/10/2011

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