MEDICARE: BYRON STRAKUSEK 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	051288212	IL

General Provider Information

NPI Number	:	1811421340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYRON STRAKUSEK RPH.

Provider Business Mailing Address
First Line	:	1778 SOMERSET LN
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-5363
Country	:	US
Telephone Number	:	224-392-2666
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 N SEYMOUR AVE
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-2318
Country	:	US
Telephone Number	:	224-392-2666
Fax Number	:

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

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	04/11/2017

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