MEDICARE: DR. MARLOWE MEGAN DJURIC 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	051-290691	IL

General Provider Information

NPI Number	:	1497960405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARLOWE MEGAN DJURIC PHARM.D.

Provider Business Mailing Address
First Line	:	722 W MAXWELL ST
Second Line	:	SUITE 205
City	:	CHICAGO
State	:	IL
Zip	:	60607-5002
Country	:	US
Telephone Number	:	312-355-2405
Fax Number	:	312-413-3727

Provider Business Practice Location Address
First Line	:	722 W MAXWELL ST
Second Line	:	SUITE 205
City	:	CHICAGO
State	:	IL
Zip	:	60607-5002
Country	:	US
Telephone Number	:	312-355-2405
Fax Number	:	312-413-3727

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

Provider Enumeration Date	:	05/12/2007
Last Update Date	:	07/08/2007

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