=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376991851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPER CARE PHARMACY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2016
-----------------------------------------------------
Last Update Date | 09/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8305 SKOKIE BLVD.
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-2546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-983-8856
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8305 SKOKIE BLVD
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-2546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-983-8856
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JAWAD RABI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-983-8856
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 054.019585
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------