MEDICARE: GREGORY PRIMUTH 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	051.288249	IL

General Provider Information

NPI Number	:	1427760875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY PRIMUTH RPH

Provider Business Mailing Address
First Line	:	910 S MICHIGAN AVE APT 512
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2268
Country	:	US
Telephone Number	:	404-664-6620
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W RANDOLPH ST STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-3377
Country	:	US
Telephone Number	:	404-664-6620
Fax Number	:

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

Provider Enumeration Date	:	12/16/2022
Last Update Date	:	12/16/2022

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Directions to “ GREGORY PRIMUTH RPH” Practice Location

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