MEDICARE: BAHATI FERNANDEZ 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	051291921	IL
2	183500000X	Pharmacist	033269823	OH

General Provider Information

NPI Number	:	1356748735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAHATI FERNANDEZ PHARMD

Provider Business Mailing Address
First Line	:	4626 W DIVERSEY AVE
Second Line	:	WALMART PHARMACY
City	:	CHICAGO
State	:	IL
Zip	:	60639-1829
Country	:	US
Telephone Number	:	773-628-1883
Fax Number	:	773-628-1884

Provider Business Practice Location Address
First Line	:	4626 W DIVERSEY AVE
Second Line	:	WALMART PHARMACY
City	:	CHICAGO
State	:	IL
Zip	:	60639-1829
Country	:	US
Telephone Number	:	773-628-1883
Fax Number	:	773-628-1884

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

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	08/26/2015

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Directions to “ BAHATI FERNANDEZ PHARMD” Practice Location

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