MEDICARE: ELAINE VILLANUEVA

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	051295785	IL

General Provider Information

NPI Number	:	1891041000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE VILLANUEVA

Provider Business Mailing Address
First Line	:	2021 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-5549
Country	:	US
Telephone Number	:	773-799-9004
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-1727
Country	:	US
Telephone Number	:	312-274-1706
Fax Number	:

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

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	02/02/2015

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Directions to “ ELAINE VILLANUEVA ” Practice Location

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