MEDICARE: PHARMCO PHARMACY LLC

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1306771977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMCO PHARMACY LLC

Provider Business Mailing Address
First Line	:	6330 S KING DR STE A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-3115
Country	:	US
Telephone Number	:	312-937-7814
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 S KING DR STE A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-3115
Country	:	US
Telephone Number	:	312-937-7814
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. GERALD DONNELLE SPARKS
Credential	:
Telephone Number	:	312-937-7814

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “PHARMCO PHARMACY LLC ” Practice Location

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