MEDICARE: DR. JASON YUEN 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051.295878	IL
2	183500000X	Pharmacist	051.295878	IL

General Provider Information

NPI Number	:	1114317658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON YUEN PHARMD

Provider Business Mailing Address
First Line	:	2112 N. ASHLAND AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614
Country	:	US
Telephone Number	:	773-342-6680
Fax Number	:	773-342-6938

Provider Business Practice Location Address
First Line	:	2112 N. ASHLAND AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614
Country	:	US
Telephone Number	:	773-342-6680
Fax Number	:	773-342-6938

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

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	02/25/2020

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