MEDICARE: MELISSA NEVENHOVEN

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	051038030	IL

General Provider Information

NPI Number	:	1477008472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA NEVENHOVEN

Provider Business Mailing Address
First Line	:	177 E ROOSEVELT RD
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3966
Country	:	US
Telephone Number	:	630-293-5360
Fax Number	:

Provider Business Practice Location Address
First Line	:	177 E ROOSEVELT RD
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3966
Country	:	US
Telephone Number	:	630-293-5360
Fax Number	:

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

Provider Enumeration Date	:	08/18/2016
Last Update Date	:	08/18/2016

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Directions to “ MELISSA NEVENHOVEN ” Practice Location

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