MEDICARE: DEL KAR PHARMACY 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	333600000X	Pharmacy	054009146	IL

General Provider Information

NPI Number	:	1063402345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEL KAR PHARMACY INC.

Provider Business Mailing Address
First Line	:	3726 W 16TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-2026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3726 W 16TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-2026
Country	:	US
Telephone Number	:	773-762-5058
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. EDWIN JEROME MULDROW
Credential	:
Telephone Number	:	773-762-5058

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	06/12/2008

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Directions to “DEL KAR PHARMACY INC. ” Practice Location

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