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NPI Code Detail

MEDICARE: 200 PHARMACY INC

MEDICARE: 200 PHARMACY INC
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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0004XCompounding Pharmacy
3333600000XPharmacy
43336C0003XCommunity/Retail Pharmacy051032504IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11445178OTHEROTHER ID NUMBER

General Provider Information

NPI Number : 1285635094
Entity Type Code : Organization
Provider Name (Legal Business Name) : 200 PHARMACY INC
Provider Business Mailing Address
First Line : 9133 S STONY ISLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-3512
Country : US
Telephone Number : 773-374-4550
Fax Number : 773-374-4660
Provider Business Practice Location Address
First Line : 9133 S STONY ISLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-3512
Country : US
Telephone Number : 773-374-4550
Fax Number : 773-374-4660
Authorized Official
Title or Position : REG PHARMACIST AND VP
Name : SHERMAN WHITE
Credential : RPH
Telephone Number : 773-374-4550
Provider Enumeration Date : 08/02/2005
Last Update Date : 05/23/2011

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Directions to “200 PHARMACY INC ” Practice Location

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