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NPI Code Detail

MEDICARE: MARK MCCARTHY

MEDICARE:   MARK  MCCARTHY
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
1183500000XPharmacist051.294924IL

General Provider Information

NPI Number : 1720351752
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK MCCARTHY
Provider Business Mailing Address
First Line : 13501 CICERO AVE
Second Line :
City : CRESTWOOD
State : IL
Zip : 60445-1934
Country : US
Telephone Number : 708-396-1280
Fax Number :
Provider Business Practice Location Address
First Line : 13501 CICERO AVE
Second Line :
City : CRESTWOOD
State : IL
Zip : 60445-1934
Country : US
Telephone Number : 708-396-1280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2012
Last Update Date : 02/22/2012

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Directions to “ MARK MCCARTHY ” Practice Location

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