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NPI Code Detail

MEDICARE: MR. GERALD JAMES WASIK JR.

MEDICARE: MR. GERALD JAMES WASIK JR.
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
1183500000XPharmacist051041019IL

General Provider Information

NPI Number : 1356624308
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GERALD JAMES WASIK JR.
Provider Business Mailing Address
First Line : 3019 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3726
Country : US
Telephone Number : 708-502-7875
Fax Number :
Provider Business Practice Location Address
First Line : 3019 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3726
Country : US
Telephone Number : 708-502-7875
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2011
Last Update Date : 09/26/2011

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