MEDICARE: AMY L PETERS 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	051-286745	IL

General Provider Information

NPI Number	:	1124395439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY L PETERS PHARMD

Provider Business Mailing Address
First Line	:	1400 E LAKE COOK RD
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-8217
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4774 WELLINGTON DR
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047-5223
Country	:	US
Telephone Number	:	630-776-4285
Fax Number	:

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

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/30/2011

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