MEDICARE: MR. JOSEPH GAMMARIELLO RPH

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	5302030133	MI
2	183500000X	Pharmacist		IL

General Provider Information

NPI Number	:	1407865850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH GAMMARIELLO RPH

Provider Business Mailing Address
First Line	:	1521 E 53RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4509
Country	:	US
Telephone Number	:	773-288-8700
Fax Number	:	773-288-7963

Provider Business Practice Location Address
First Line	:	1521 E 53RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4509
Country	:	US
Telephone Number	:	773-288-8700
Fax Number	:	773-288-7963

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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