MEDICARE: NORTH PARK 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	054019665	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2157846	OTHER		PK

General Provider Information

NPI Number	:	1194183517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH PARK PHARMACY LLC

Provider Business Mailing Address
First Line	:	3324 W FOSTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-4813
Country	:	US
Telephone Number	:	773-654-3658
Fax Number	:	773-624-7635

Provider Business Practice Location Address
First Line	:	3324 W FOSTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-4813
Country	:	US
Telephone Number	:	773-654-3658
Fax Number	:	773-624-7635

Authorized Official
Title or Position	:	PHARMACIST-IN-CHARGE
Name	:	ZAHEER PATEL
Credential	:
Telephone Number	:	773-654-3658

Provider Enumeration Date	:	01/29/2016
Last Update Date	:	03/24/2017

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