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NPI Code Detail

MEDICARE: WALKERS COTTAGE APOTHECARY INC

MEDICARE: WALKERS COTTAGE APOTHECARY 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
13336C0003XCommunity/Retail PharmacyIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11438248OTHERNCPDP

General Provider Information

NPI Number : 1093820656
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALKERS COTTAGE APOTHECARY INC
Provider Business Mailing Address
First Line : 654 E 47TH STREET
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4224
Country : US
Telephone Number : 773-924-6723
Fax Number : 773-924-6817
Provider Business Practice Location Address
First Line : 654 E 47TH STREET
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4224
Country : US
Telephone Number : 773-924-6723
Fax Number : 773-924-6817
Authorized Official
Title or Position : PRESIDENT
Name : MR. LEON G WALKER
Credential : RPH
Telephone Number : 773-924-6723
Provider Enumeration Date : 08/21/2006
Last Update Date : 08/22/2020

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Directions to “WALKERS COTTAGE APOTHECARY INC ” Practice Location

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