MEDICARE: ANETA PITULA 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	183500000X	Pharmacist	051291336	IL

General Provider Information

NPI Number	:	1528353661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANETA PITULA PHARMD

Provider Business Mailing Address
First Line	:	12103 S 75TH AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2675
Country	:	US
Telephone Number	:	708-741-4070
Fax Number	:

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

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	06/16/2011

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