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NPI Code Detail

MEDICARE: ABRAHAM AVALOS PHARM D

MEDICARE: ABRAHAM AVALOS 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
1183500000XPharmacist051299262IL

General Provider Information

NPI Number : 1720690431
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABRAHAM AVALOS PHARM D
Provider Business Mailing Address
First Line : 5222 W MADISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60644-4141
Country : US
Telephone Number :
Fax Number :
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 :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2020
Last Update Date : 08/24/2020

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Directions to “ ABRAHAM AVALOS PHARM D” Practice Location

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