MEDICARE: TOMAS GARBALIAUSKAS PHARMACIST

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	051302454	IL

General Provider Information

NPI Number	:	1144878687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMAS GARBALIAUSKAS PHARMACIST

Provider Business Mailing Address
First Line	:	500 THORNTON ST
Second Line	:
City	:	LOCKPORT
State	:	IL
Zip	:	60441-3172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 N BLOOMINGTON ST
Second Line	:
City	:	STREATOR
State	:	IL
Zip	:	61364-1305
Country	:	US
Telephone Number	:	815-672-3071
Fax Number	:

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

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	08/28/2019

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