MEDICARE: MRS. JULIANNE M OVIST 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
1	183500000X	Pharmacist	051.039902	IL

General Provider Information

NPI Number	:	1295067403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIANNE M OVIST PHARMD

Provider Business Mailing Address
First Line	:	2020 LUNT AVE
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-5606
Country	:	US
Telephone Number	:	847-258-1920
Fax Number	:	847-258-1913

Provider Business Practice Location Address
First Line	:	2020 LUNT AVE
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-5606
Country	:	US
Telephone Number	:	847-258-1920
Fax Number	:	847-258-1913

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

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	02/12/2010

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