MEDICARE: NORTHBROOK PHARMACY 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	:	1144884164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHBROOK PHARMACY LLC

Provider Business Mailing Address
First Line	:	1908 TECHNY CT
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-5385
Country	:	US
Telephone Number	:	224-213-7088
Fax Number	:

Provider Business Practice Location Address
First Line	:	1908 TECHNY CT
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-5385
Country	:	US
Telephone Number	:	224-213-7088
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HASSAN CHAMI
Credential	:	PHARMD
Telephone Number	:	224-213-7088

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	06/10/2019

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