MEDICARE: DR. JULIO VILLAFUERTE PHARM.D.

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	051.299557	IL

General Provider Information

NPI Number	:	1497297303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIO VILLAFUERTE PHARM.D.

Provider Business Mailing Address
First Line	:	5324 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4224
Country	:	US
Telephone Number	:	773-284-7402
Fax Number	:	773-284-0366

Provider Business Practice Location Address
First Line	:	5324 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4224
Country	:	US
Telephone Number	:	773-284-7402
Fax Number	:	773-284-0366

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

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	11/08/2016

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