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General NPI Number Information
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NPI Number | 1053425264
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Entity Type | Organization
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Legal Business Name | VICS PHARMACY
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 1313 W MORSE AVE UNIT B
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City | CHICAGO
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State | IL
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Zip | 60626-3521
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Country | US
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Telephone | 773-764-0044
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Fax | 773-764-1126
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Provider Business Mailing Address
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Address Line | 1313 W MORSE AVE UNIT B
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City | CHICAGO
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State | IL
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Zip | 60626-3521
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Country | US
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Telephone | 773-764-0044
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Fax | 773-764-1126
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD MBACHU
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Credential | PHARMACIST
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Telephone | 773-764-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 051029448
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License Number State | IL
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