MEDICARE: DAWN L RUSH

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	051-038476	IL

General Provider Information

NPI Number	:	1235414004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN L RUSH

Provider Business Mailing Address
First Line	:	12854 S ASHLAND AVE
Second Line	:
City	:	CALUMET PARK
State	:	IL
Zip	:	60827-6308
Country	:	US
Telephone Number	:	708-239-1136
Fax Number	:	708-239-1146

Provider Business Practice Location Address
First Line	:	12854 S ASHLAND AVE
Second Line	:
City	:	CALUMET PARK
State	:	IL
Zip	:	60827-6308
Country	:	US
Telephone Number	:	708-239-1136
Fax Number	:	708-239-1146

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

Provider Enumeration Date	:	10/12/2011
Last Update Date	:	10/12/2011

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