MEDICARE: MR. ANTHONY M MENSIK 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		IL

General Provider Information

NPI Number	:	1316165210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY M MENSIK RPH

Provider Business Mailing Address
First Line	:	1320 YELLOWSTONE PKWY
Second Line	:
City	:	ALGONQUIN
State	:	IL
Zip	:	60102-5422
Country	:	US
Telephone Number	:	847-458-8160
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N RICHMOND RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-1419
Country	:	US
Telephone Number	:	815-344-8340
Fax Number	:	815-344-8374

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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