MEDICARE: SCOTT MICHAEL DRABANT RPH

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		IL

General Provider Information

NPI Number	:	1760474332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT MICHAEL DRABANT RPH

Provider Business Mailing Address
First Line	:	5805 BROADWAY ST
Second Line	:
City	:	RICHMOND
State	:	IL
Zip	:	60071-9534
Country	:	US
Telephone Number	:	815-678-4577
Fax Number	:	815-759-8090

Provider Business Practice Location Address
First Line	:	5805 BROADWAY ST
Second Line	:
City	:	RICHMOND
State	:	IL
Zip	:	60071-9534
Country	:	US
Telephone Number	:	815-678-4577
Fax Number	:	815-759-8090

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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