MEDICARE: MS. LENGLILY KRUY 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	051294539	IL

General Provider Information

NPI Number	:	1588082598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LENGLILY KRUY PHARM D.

Provider Business Mailing Address
First Line	:	5145 NORTH CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 NORTH CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625
Country	:	US
Telephone Number	:	773-989-3810
Fax Number	:

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

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	04/07/2014

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