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NPI Code Detail

MEDICARE: CHINCHU PERUMBEL JOHN

MEDICARE: CHINCHU PERUMBEL JOHN
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
1183500000XPharmacist051.304572IL

General Provider Information

NPI Number : 1851041628
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHINCHU PERUMBEL JOHN
Provider Business Mailing Address
First Line : 4330 N MEADE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60634-1522
Country : US
Telephone Number : 224-415-5584
Fax Number :
Provider Business Practice Location Address
First Line : 4748 W NORTH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-4640
Country : US
Telephone Number : 773-745-6642
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2022
Last Update Date : 03/25/2022

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Directions to “ CHINCHU PERUMBEL JOHN ” Practice Location

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