MEDICARE: GEORGE HESEQIAL 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	051289131	IL

General Provider Information

NPI Number	:	1396028007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE HESEQIAL PHARMD

Provider Business Mailing Address
First Line	:	3755 CLIFFORD TER
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-2846
Country	:	US
Telephone Number	:	773-919-0976
Fax Number	:

Provider Business Practice Location Address
First Line	:	5158 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2521
Country	:	US
Telephone Number	:	773-907-8490
Fax Number	:

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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Directions to “ GEORGE HESEQIAL PHARMD” Practice Location

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