MEDICARE: SINAI TOUCHY PHARMACY L L C

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	054014520	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2020916	OTHER		PK

General Provider Information

NPI Number	:	1144307596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SINAI TOUCHY PHARMACY L L C

Provider Business Mailing Address
First Line	:	2907 W TOUHY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-2937
Country	:	US
Telephone Number	:	773-274-3593
Fax Number	:	773-274-3741

Provider Business Practice Location Address
First Line	:	2907 W TOUHY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-2937
Country	:	US
Telephone Number	:	773-274-3593
Fax Number	:	773-274-3741

Authorized Official
Title or Position	:	EXECT MANG
Name	:	EDWARD FOX
Credential	:
Telephone Number	:	847-673-2424

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/19/2016

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