MEDICARE: MRS. MARY C YERKES RPH

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	051034318	IL

General Provider Information

NPI Number	:	1245836097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY C YERKES RPH

Provider Business Mailing Address
First Line	:	36 FOREST AVE
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-2002
Country	:	US
Telephone Number	:	708-860-8509
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 W NORTH AVE
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1630
Country	:	US
Telephone Number	:	708-538-4941
Fax Number	:	708-538-4673

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

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	12/08/2020

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