MEDICARE: TOUHY PHARMACY ENTERPRISES 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
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy	054016993	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1420051	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1396850327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOUHY PHARMACY ENTERPRISES INC

Provider Business Mailing Address
First Line	:	2721 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3919
Country	:	US
Telephone Number	:	773-334-3193
Fax Number	:	773-334-1595

Provider Business Practice Location Address
First Line	:	2721 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3919
Country	:	US
Telephone Number	:	773-334-3193
Fax Number	:	773-334-1595

Authorized Official
Title or Position	:	MANAGER
Name	:	WILLIAM KLIEN
Credential	:
Telephone Number	:	773-354-3193

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	03/19/2010

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