MEDICARE: MRS. KELLY ANNE MARINI 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	051289620	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649565912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY ANNE MARINI PHARM D

Provider Business Mailing Address
First Line	:	555 S RAND RD
Second Line	:	T-1036
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2356
Country	:	US
Telephone Number	:	847-726-2584
Fax Number	:	847-726-2584

Provider Business Practice Location Address
First Line	:	555 S RAND RD
Second Line	:	T-1036
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2356
Country	:	US
Telephone Number	:	847-726-2584
Fax Number	:	847-726-2584

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

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/15/2011

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