MEDICARE: PHARMACY HEALTHCARE SOLUTIONS LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	054017829	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2133592	OTHER		PK

General Provider Information

NPI Number	:	1023389434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY HEALTHCARE SOLUTIONS LTD

Provider Business Mailing Address
First Line	:	2775 SANDERS RD STE C1
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-6110
Country	:	US
Telephone Number	:	847-402-9400
Fax Number	:	847-402-9420

Provider Business Practice Location Address
First Line	:	2775 SANDERS RD STE C1
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-6110
Country	:	US
Telephone Number	:	847-402-9400
Fax Number	:	847-402-9420

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	TERRY FORREST
Credential	:	RPH
Telephone Number	:	901-409-7091

Provider Enumeration Date	:	01/16/2012
Last Update Date	:	06/17/2016

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