MEDICARE: SEOUL PHARMACY

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	054007772	IL

General Provider Information

NPI Number	:	1326111568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEOUL PHARMACY

Provider Business Mailing Address
First Line	:	3757 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3757 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5712
Country	:	US
Telephone Number	:	773-539-1234
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MELANIE LEE
Credential	:	RPH
Telephone Number	:	773-359-1234

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	02/21/2017

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Directions to “SEOUL PHARMACY ” Practice Location

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