MEDICARE: JAMES A LOVELL FEDERAL HEALTH CARE CENTER

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	332000000X	Military/U.S. Coast Guard Pharmacy

General Provider Information

NPI Number	:	1790092674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES A LOVELL FEDERAL HEALTH CARE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 322
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-0322
Country	:	US
Telephone Number	:	847-688-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 GREEN BAY RD
Second Line	:	BLDG 3452
City	:	GREAT LAKES
State	:	IL
Zip	:	60088-3303
Country	:	US
Telephone Number	:	847-688-1900
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, BUSINESS DEVELOPMENT
Name	:	BARBARA MAYERICK
Credential	:
Telephone Number	:	202-461-1550

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	09/21/2010

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