MEDICARE: MR. JASON R PERRY R.PH.

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	051.289996	IL

General Provider Information

NPI Number	:	1528378791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON R PERRY R.PH.

Provider Business Mailing Address
First Line	:	800 BIERMANN CT STE A
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-2151
Country	:	US
Telephone Number	:	909-799-4174
Fax Number	:	909-799-4364

Provider Business Practice Location Address
First Line	:	800 BIERMANN CT STE A
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-2151
Country	:	US
Telephone Number	:	909-799-4174
Fax Number	:	909-799-4364

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

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	10/20/2010

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