MEDICARE: MICHAEL JONES

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	051.302554	IL

General Provider Information

NPI Number	:	1730798729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JONES

Provider Business Mailing Address
First Line	:	1003 N WINCHESTER AVE UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3734
Country	:	US
Telephone Number	:	630-788-9997
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 N WINCHESTER AVE UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3734
Country	:	US
Telephone Number	:	630-788-9997
Fax Number	:

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

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	07/27/2020

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