MEDICARE: MS. ADRIENNE WILHELM MAG RPH, MBA

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	S11601	AZ
2	183500000X	Pharmacist		IL

General Provider Information

NPI Number	:	1891765640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ADRIENNE WILHELM MAG RPH, MBA

Provider Business Mailing Address
First Line	:	1910 S FEDERAL ST
Second Line	:	UNIT D
City	:	CHICAGO
State	:	IL
Zip	:	60616-4514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 E ROOSEVELT RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2410
Country	:	US
Telephone Number	:	312-212-1583
Fax Number	:	312-212-1588

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/08/2007

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