MEDICARE: MS. JENNIFER RENE STICKNEY 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		IL

General Provider Information

NPI Number	:	1467513416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER RENE STICKNEY RPH

Provider Business Mailing Address
First Line	:	213 W INSTITUTE PL
Second Line	:	SUITE 206
City	:	CHICAGO
State	:	IL
Zip	:	60610-3121
Country	:	US
Telephone Number	:	312-337-7750
Fax Number	:	312-337-7760

Provider Business Practice Location Address
First Line	:	213 W INSTITUTE PL
Second Line	:	SUITE 206
City	:	CHICAGO
State	:	IL
Zip	:	60610-3121
Country	:	US
Telephone Number	:	312-337-7750
Fax Number	:	312-337-7760

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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