=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396850327
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOUHY PHARMACY ENTERPRISES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 03/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2721 W PETERSON AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60659-3919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-334-3193
-----------------------------------------------------
Fax | 773-334-1595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2721 W PETERSON AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60659-3919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-334-3193
-----------------------------------------------------
Fax | 773-334-1595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | WILLIAM KLIEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-354-3193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 054016993
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------