Healthcare Provider Details

I. General information

NPI: 1306771977
Provider Name (Legal Business Name): PHARMCO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 S KING DR STE A
CHICAGO IL
60637-3115
US

IV. Provider business mailing address

6330 S KING DR STE A SUITE A
CHICAGO IL
60637-3115
US

V. Phone/Fax

Practice location:
  • Phone: 312-937-7814
  • Fax:
Mailing address:
  • Phone: 312-937-7814
  • Fax: 312-597-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. GERALD DONNELLE SPARKS
Title or Position: ADMINISTRATOR
Credential:
Phone: 312-937-7814