MEDICARE: REDI DEMA PHARMD

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	051300698	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051300698	OTHER	IL	DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

General Provider Information

NPI Number	:	1760096515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REDI DEMA PHARMD

Provider Business Mailing Address
First Line	:	3945 DEMPSTER ST
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-2263
Country	:	US
Telephone Number	:	847-674-5876
Fax Number	:

Provider Business Practice Location Address
First Line	:	3945 DEMPSTER ST
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-2263
Country	:	US
Telephone Number	:	847-674-5876
Fax Number	:

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

Provider Enumeration Date	:	08/31/2020
Last Update Date	:	08/31/2020

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Directions to “ REDI DEMA PHARMD” Practice Location

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