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NPI Code Detail

MEDICARE: MRS. JOHANNA VISA

MEDICARE:  MRS. JOHANNA  VISA
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
1183500000XPharmacist051297571IL

General Provider Information

NPI Number : 1336598341
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JOHANNA VISA
Provider Business Mailing Address
First Line : 5532 CLARK STREET
Second Line :
City : CHICAGO
State : IL
Zip : 60640
Country : US
Telephone Number : 773-784-7348
Fax Number : 773-784-1408
Provider Business Practice Location Address
First Line : 5516 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1214
Country : US
Telephone Number : 773-784-7348
Fax Number : 773-784-1408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2016
Last Update Date : 06/09/2016

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Directions to “ MRS. JOHANNA VISA ” Practice Location

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