MEDICARE: DR. JESSICA LYNN SUPERS PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051305165	IL

General Provider Information

NPI Number	:	1851067243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA LYNN SUPERS PHARMD

Provider Business Mailing Address
First Line	:	5024 N WINTHROP AVE APT 3W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-6439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4002
Country	:	US
Telephone Number	:	773-334-3736
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	06/01/2026

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