MEDICARE: MARK ALAN CHERNEY RPH

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	1835P2201X	Ambulatory Care Pharmacist	16778	NE

General Provider Information

NPI Number	:	1942897343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALAN CHERNEY RPH

Provider Business Mailing Address
First Line	:	4420 N 17TH ST
Second Line	:
City	:	CARTER LAKE
State	:	IA
Zip	:	51510-1145
Country	:	US
Telephone Number	:	708-728-5052
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 N 17TH ST
Second Line	:
City	:	CARTER LAKE
State	:	IA
Zip	:	51510-1145
Country	:	US
Telephone Number	:	708-728-5052
Fax Number	:

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

Provider Enumeration Date	:	12/31/2020
Last Update Date	:	12/31/2020

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