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General NPI Number Information
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NPI Number | 1003387226
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Entity Type | Organization
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Legal Business Name | SURECARE PHARMACY 2 INC
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 4700 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60632
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Country | US
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Telephone | 732-910-2949
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Fax |
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Provider Business Mailing Address
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Address Line | 32 WILLOW BAY DR
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City | SOUTH BARRINGTON
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State | IL
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Zip | 60010-7114
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Country | US
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Telephone | 732-910-2949
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Fax |
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Authorized Official
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Title or Position | PHARMACIST INCHARGE
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Name | RACHIT SHAH
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Credential | RPH
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Telephone | 732-910-2949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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