MEDICARE: JOAN SERGO 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	:	1295850600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN SERGO R.PH.

Provider Business Mailing Address
First Line	:	8501 WASHINGTON AVE
Second Line	:
City	:	BROOKFIELD
State	:	IL
Zip	:	60513-1705
Country	:	US
Telephone Number	:	708-387-7124
Fax Number	:

Provider Business Practice Location Address
First Line	:	259 LAKE ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-2636
Country	:	US
Telephone Number	:	708-525-1736
Fax Number	:	708-383-9172

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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Directions to “ JOAN SERGO R.PH.” Practice Location

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