MEDICARE: JAMES WALL

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	27680	TX
2	183500000X	Pharmacist	041455	MO
3	183500000X	Pharmacist	1-15107	KS

General Provider Information

NPI Number	:	1992066070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WALL

Provider Business Mailing Address
First Line	:	8001 N. LINCOLN AVE, SUITE 800
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3695
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5805 N POLK DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2691
Country	:	US
Telephone Number	:	816-505-3560
Fax Number	:	816-505-3560

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/05/2012

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Directions to “ JAMES WALL ” Practice Location

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