MEDICARE: DR. MARK TRUTY II PHARMD, 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	051290693	IL
2	183500000X	Pharmacist	20945	IA

General Provider Information

NPI Number	:	1821346552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK TRUTY II PHARMD, RPH

Provider Business Mailing Address
First Line	:	113 W MICHIGAN ST
Second Line	:
City	:	OTTAWA
State	:	IL
Zip	:	61350-2028
Country	:	US
Telephone Number	:	815-434-5355
Fax Number	:	815-434-9457

Provider Business Practice Location Address
First Line	:	113 W MICHIGAN ST
Second Line	:
City	:	OTTAWA
State	:	IL
Zip	:	61350-2028
Country	:	US
Telephone Number	:	815-434-5355
Fax Number	:	815-434-9457

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

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	08/28/2012

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