MEDICARE: MR. DUANE E MACHAJ 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	:	1366539066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUANE E MACHAJ R.PH.

Provider Business Mailing Address
First Line	:	900 S DAMEN AVE
Second Line	:	PHARMACY 119
City	:	CHICAGO
State	:	IL
Zip	:	60612-3730
Country	:	US
Telephone Number	:	312-569-6131
Fax Number	:	312-569-8812

Provider Business Practice Location Address
First Line	:	900 S DAMEN AVE
Second Line	:	PHARMACY 119
City	:	CHICAGO
State	:	IL
Zip	:	60612-3730
Country	:	US
Telephone Number	:	312-569-6131
Fax Number	:	312-569-8812

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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