MEDICARE: 1918 WINTER STREET OPERATING CO LLC

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	:	1104674845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1918 WINTER STREET OPERATING CO LLC

Provider Business Mailing Address
First Line	:	7 CORPORATE DR
Second Line	:
City	:	KEENE
State	:	NH
Zip	:	03431-5042
Country	:	US
Telephone Number	:	603-354-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 W 63RD ST
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-2614
Country	:	US
Telephone Number	:	630-964-5056
Fax Number	:	630-964-4654

Authorized Official
Title or Position	:	AUTHORIZED PERSON
Name	:	KEVIN MCNAMARA
Credential	:
Telephone Number	:	603-354-4619

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	07/24/2024

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