MEDICARE: DONALD D. VAN LIER R.PH.

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		IL

General Provider Information

NPI Number	:	1275583221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD D. VAN LIER R.PH.

Provider Business Mailing Address
First Line	:	31 BUTTERFIELD RD
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-1349
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	980 ELK GROVE TOWN CTR
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3754
Country	:	US
Telephone Number	:	847-758-8524
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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