MEDICARE: DR. TOMASZ KACZOR PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051.290479	IL

General Provider Information

NPI Number	:	1477187425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMASZ KACZOR PHARMD

Provider Business Mailing Address
First Line	:	7401 W LAWRENCE AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-3411
Country	:	US
Telephone Number	:	708-867-8564
Fax Number	:	708-867-8586

Provider Business Practice Location Address
First Line	:	7401 W LAWRENCE AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-3411
Country	:	US
Telephone Number	:	708-867-8564
Fax Number	:	708-867-8586

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

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	02/28/2020

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