MEDICARE: VIJAY G DOSHETTY 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	054.017928	IL

General Provider Information

NPI Number	:	1235470345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJAY G DOSHETTY PHARM D

Provider Business Mailing Address
First Line	:	8811 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-2810
Country	:	US
Telephone Number	:	773-359-4132
Fax Number	:

Provider Business Practice Location Address
First Line	:	8811 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-2810
Country	:	US
Telephone Number	:	773-359-4132
Fax Number	:

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

Provider Enumeration Date	:	03/14/2013
Last Update Date	:	03/14/2013

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