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NPI Code Detail

MEDICARE: SUNDIS I ISLEFO PHARMACIST

MEDICARE:   SUNDIS I ISLEFO  PHARMACIST
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
1183500000XPharmacist051.301151IL

General Provider Information

NPI Number : 1427657063
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUNDIS I ISLEFO PHARMACIST
Provider Business Mailing Address
First Line : 2647 W RASCHER AVE APT 2W
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3106
Country : US
Telephone Number : 773-556-8331
Fax Number :
Provider Business Practice Location Address
First Line : 2647 W RASCHER AVE APT 2W
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3106
Country : US
Telephone Number : 773-556-8331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2020
Last Update Date : 10/24/2020

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Directions to “ SUNDIS I ISLEFO PHARMACIST” Practice Location

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