Healthcare Provider Details

I. General information

NPI: 1144385576
Provider Name (Legal Business Name): MASCOT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAIN ST
PARK RIDGE IL
60068-4030
US

IV. Provider business mailing address

110 MAIN ST
PARK RIDGE IL
60068-4030
US

V. Phone/Fax

Practice location:
  • Phone: 847-698-3323
  • Fax: 847-698-4112
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number054014403
License Number StateIL

VIII. Authorized Official

Name: MARIA L COSTA
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 847-698-3323