MEDICARE: MISS LADY AMABELLE A MASANGCAY PHARMD

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	183500000X	Pharmacist		IL

General Provider Information

NPI Number	:	1669656856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LADY AMABELLE A MASANGCAY PHARMD

Provider Business Mailing Address
First Line	:	3531 N BROADWAY ST
Second Line	:	OSCO PHARMACY
City	:	CHICAGO
State	:	IL
Zip	:	60657-1825
Country	:	US
Telephone Number	:	773-528-6615
Fax Number	:	773-404-6916

Provider Business Practice Location Address
First Line	:	3531 N BROADWAY AVE
Second Line	:	OSCO PHARMACY
City	:	CHICAGO
State	:	IL
Zip	:	60657-1825
Country	:	US
Telephone Number	:	773-528-6615
Fax Number	:	773-404-6916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	12/24/2007

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