MEDICARE: MR. JAVIER P COSME

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	051037534	IL

General Provider Information

NPI Number	:	1629359930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAVIER P COSME

Provider Business Mailing Address
First Line	:	4745 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4410
Country	:	US
Telephone Number	:	773-481-0211
Fax Number	:	773-481-0242

Provider Business Practice Location Address
First Line	:	4745 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4410
Country	:	US
Telephone Number	:	773-481-0211
Fax Number	:	773-481-0242

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

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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Directions to “ MR. JAVIER P COSME ” Practice Location

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