MEDICARE: MICHAEL PAUL GEROU PHARM D

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	051.289975	IL

General Provider Information

NPI Number	:	1194000802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PAUL GEROU PHARM D

Provider Business Mailing Address
First Line	:	3646 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4418
Country	:	US
Telephone Number	:	773-549-3808
Fax Number	:	773-549-1054

Provider Business Practice Location Address
First Line	:	3646 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4418
Country	:	US
Telephone Number	:	773-549-3808
Fax Number	:	773-549-1054

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

Provider Enumeration Date	:	10/13/2011
Last Update Date	:	10/13/2011

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