MEDICARE: JOO MI OH 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	051293455	IL

General Provider Information

NPI Number	:	1629378625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOO MI OH PHARMD

Provider Business Mailing Address
First Line	:	6312 N NAGLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3614
Country	:	US
Telephone Number	:	773-272-3065
Fax Number	:	773-272-3052

Provider Business Practice Location Address
First Line	:	6312 N NAGLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3614
Country	:	US
Telephone Number	:	773-272-3065
Fax Number	:	773-272-3052

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

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	10/25/2010

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