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NPI Code Detail

MEDICARE: DR. MARVIN CRAIG PROTASIO PHARMD

MEDICARE: DR. MARVIN CRAIG PROTASIO 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
1183500000XPharmacist051.293717IL

General Provider Information

NPI Number : 1245687771
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARVIN CRAIG PROTASIO PHARMD
Provider Business Mailing Address
First Line : 2550 N CLYBOURN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1941
Country : US
Telephone Number : 773-348-7421
Fax Number :
Provider Business Practice Location Address
First Line : 2550 N CLYBOURN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1941
Country : US
Telephone Number : 773-348-7421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2016
Last Update Date : 05/13/2016

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