MEDICARE: DR. PHARRAH THOMAS 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	183500000X	Pharmacist	051294613	IL

General Provider Information

NPI Number	:	1902188048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHARRAH THOMAS PHARMD

Provider Business Mailing Address
First Line	:	2601 E SAUK TRL
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411-5262
Country	:	US
Telephone Number	:	708-757-6906
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 E SAUK TRL
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411-5262
Country	:	US
Telephone Number	:	708-757-6906
Fax Number	:

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

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	09/14/2011

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