MEDICARE: MR. WILLIAM A NELSON 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	051-035713	IL
2	183500000X	Pharmacist	8253-040	WI
3	183500000X	Pharmacist	14110	NV

General Provider Information

NPI Number	:	1427122167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM A NELSON R.PH.

Provider Business Mailing Address
First Line	:	973 W ESSEX PL
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-2317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	973 W ESSEX PL
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-2317
Country	:	US
Telephone Number	:	847-255-1718
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	12/12/2009

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