MEDICARE: GLENDA CRIMALDI

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	051035163	IL

General Provider Information

NPI Number	:	1962626036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA CRIMALDI

Provider Business Mailing Address
First Line	:	6736 N LORON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-1410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6312 N NAGLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3614
Country	:	US
Telephone Number	:	773-272-3065
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	09/30/2013

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Directions to “ GLENDA CRIMALDI ” Practice Location

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