MEDICARE: JUAN DAVID CAVIEDES 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	051307734	IL

General Provider Information

NPI Number	:	1164385076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN DAVID CAVIEDES PHARMD

Provider Business Mailing Address
First Line	:	5516 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5516 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1214
Country	:	US
Telephone Number	:	773-784-7348
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ JUAN DAVID CAVIEDES PHARMD” Practice Location

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