MEDICARE: FAMILY FARMACIA 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	3336C0003X	Community/Retail Pharmacy	054009199	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1454836	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1588716831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FARMACIA INC

Provider Business Mailing Address
First Line	:	4242 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3647
Country	:	US
Telephone Number	:	773-227-8874
Fax Number	:	773-227-8284

Provider Business Practice Location Address
First Line	:	4242 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3647
Country	:	US
Telephone Number	:	773-227-8874
Fax Number	:	773-227-8284

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAHENDRA PATEL
Credential	:	RPH
Telephone Number	:	773-227-8874

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	05/04/2010

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