=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356661821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDWEST PHARMACIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2010
-----------------------------------------------------
Last Update Date | 05/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 SUPERIOR ST
-----------------------------------------------------
City | MELROSE PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60160-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-665-6000
-----------------------------------------------------
Fax | 615-665-6184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 BURTON HILLS BLVD SUITE 100
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37215-6197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-665-6000
-----------------------------------------------------
Fax | 615-665-6184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | MS. ANN E MONTGOMERY
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 708-763-1398
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------