MEDICARE: SURECARE 2 INC.

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1053996249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURECARE 2 INC.

Provider Business Mailing Address
First Line	:	4104 W 63RD ST STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5008
Country	:	US
Telephone Number	:	708-350-5252
Fax Number	:	708-350-5255

Provider Business Practice Location Address
First Line	:	4104 W 63RD ST STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5008
Country	:	US
Telephone Number	:	708-350-5252
Fax Number	:	708-350-5255

Authorized Official
Title or Position	:	PHARMACY INCHARGE
Name	:	RACHIT SHAH
Credential	:	RPH
Telephone Number	:	708-350-5252

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	04/12/2024

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