MEDICARE: BECKER PROFESSIONAL PHARMACY 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
1	332B00000X	Durable Medical Equipment & Medical Supplies	54004739	IL

General Provider Information

NPI Number	:	1205837820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BECKER PROFESSIONAL PHARMACY INC

Provider Business Mailing Address
First Line	:	4744 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2013
Country	:	US
Telephone Number	:	773-561-4486
Fax Number	:	773-334-3162

Provider Business Practice Location Address
First Line	:	4744 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2013
Country	:	US
Telephone Number	:	773-561-4486
Fax Number	:	773-334-3162

Authorized Official
Title or Position	:	PRESIDENT/PHARMACIST IN CHARGE
Name	:	MR. ALVIN CHARLES KLEIN
Credential	:	RPH
Telephone Number	:	773-561-4486

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	08/22/2020

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