MEDICARE: DR. JACOB PATRICK GETTIG PHARMD, BCPS

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	1835P1200X	Pharmacotherapy Pharmacist	51289906	IL
2	1835P1200X	Pharmacotherapy Pharmacist	26021016A	IN

General Provider Information

NPI Number	:	1407960933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB PATRICK GETTIG PHARMD, BCPS

Provider Business Mailing Address
First Line	:	3175 CAMBRIA CT
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60503-5751
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 31ST ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1235
Country	:	US
Telephone Number	:	630-515-7324
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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