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NPI Code Detail

MEDICARE: HALSTED PHARMACY INC

MEDICARE: HALSTED 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
1333600000XPharmacy
23336C0004XCompounding Pharmacy
33336C0003XCommunity/Retail Pharmacy054-017440IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12125361OTHERPK

General Provider Information

NPI Number : 1285954545
Entity Type Code : Organization
Provider Name (Legal Business Name) : HALSTED PHARMACY INC
Provider Business Mailing Address
First Line : 1460 N HALSTED ST STE 101
Second Line :
City : CHICAGO
State : IL
Zip : 60642-2620
Country : US
Telephone Number : 312-624-9397
Fax Number : 312-624-8826
Provider Business Practice Location Address
First Line : 1460 N HALSTED ST STE 101
Second Line :
City : CHICAGO
State : IL
Zip : 60642-2620
Country : US
Telephone Number : 312-624-9397
Fax Number : 312-624-8826
Authorized Official
Title or Position : DIR OF PHARMACY/SECRETARY
Name : RENNY KURUP
Credential : PHARMD
Telephone Number : 312-624-9397
Provider Enumeration Date : 06/09/2010
Last Update Date : 03/18/2016

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Directions to “HALSTED PHARMACY INC ” Practice Location

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