MEDICARE: FARMACIA CRX 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	054020653	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2176470	OTHER		PK

General Provider Information

NPI Number	:	1760985436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACIA CRX INC.

Provider Business Mailing Address
First Line	:	5941 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2618
Country	:	US
Telephone Number	:	773-466-9418
Fax Number	:	773-336-8246

Provider Business Practice Location Address
First Line	:	5941 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2618
Country	:	US
Telephone Number	:	773-466-9418
Fax Number	:	872-813-5257

Authorized Official
Title or Position	:	OWNER
Name	:	GABINO RAFAELA
Credential	:
Telephone Number	:	773-466-9418

Provider Enumeration Date	:	03/08/2018
Last Update Date	:	05/13/2022

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