MEDICARE: PILSEN PHARMACY

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	054018154	IL

General Provider Information

NPI Number	:	1598103194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PILSEN PHARMACY

Provider Business Mailing Address
First Line	:	1868 S BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3013
Country	:	US
Telephone Number	:	312-993-9500
Fax Number	:	312-993-9501

Provider Business Practice Location Address
First Line	:	1868 S BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3013
Country	:	US
Telephone Number	:	312-993-9500
Fax Number	:	312-993-9501

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	DR. ROBERT ZAVALA
Credential	:	PHARMD
Telephone Number	:	773-531-2058

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	06/05/2013

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Directions to “PILSEN PHARMACY ” Practice Location

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