MEDICARE: UPTOWN 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	332B00000X	Durable Medical Equipment & Medical Supplies	054-019426	IL
2	3336C0003X	Community/Retail Pharmacy	054-019426	IL
3	3336C0004X	Compounding Pharmacy	054-019426	IL
4	333600000X	Pharmacy	054-019426	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	054-019426	OTHER	IL	IL DEPT OF FINANCIAL AND PROFESSIONAL REGULATION

General Provider Information

NPI Number	:	1083090575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPTOWN PHARMACY, INC.

Provider Business Mailing Address
First Line	:	4535 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-7611
Country	:	US
Telephone Number	:	773-944-0525
Fax Number	:	773-944-0632

Provider Business Practice Location Address
First Line	:	4535 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-7611
Country	:	US
Telephone Number	:	773-944-0525
Fax Number	:	773-944-0632

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDUARDO ALPIZAR
Credential	:
Telephone Number	:	773-944-0525

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	08/06/2015

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