MEDICARE: HERMOSA 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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1366981300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERMOSA PHARMACY INC

Provider Business Mailing Address
First Line	:	2006 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639
Country	:	US
Telephone Number	:	773-227-1211
Fax Number	:

Provider Business Practice Location Address
First Line	:	2006 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639
Country	:	US
Telephone Number	:	773-227-1211
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABEER ZAGHMOURY
Credential	:
Telephone Number	:	708-228-1505

Provider Enumeration Date	:	02/22/2017
Last Update Date	:	02/22/2017

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Directions to “HERMOSA PHARMACY INC ” Practice Location

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