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NPI Code Detail

MEDICARE: DR. REGINA Y ANDERSON-BRACEY

MEDICARE:  DR. REGINA Y ANDERSON-BRACEY
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
1183500000XPharmacist051-286840IL

General Provider Information

NPI Number : 1720342942
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REGINA Y ANDERSON-BRACEY
Provider Business Mailing Address
First Line : 5222 W MADISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60644-4141
Country : US
Telephone Number : 773-287-0380
Fax Number : 773-287-4534
Provider Business Practice Location Address
First Line : 5222 W MADISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60644-4141
Country : US
Telephone Number : 773-287-0380
Fax Number : 773-287-4534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2012
Last Update Date : 07/02/2012

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Directions to “ DR. REGINA Y ANDERSON-BRACEY ” Practice Location

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