MEDICARE: WESTEND 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	183500000X	Pharmacist	051.031457	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1437676	OTHER	IL	NABP #

General Provider Information

NPI Number	:	1437200706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTEND PHARMACY

Provider Business Mailing Address
First Line	:	2805 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3332
Country	:	US
Telephone Number	:	177-353-3054
Fax Number	:	177-353-3054

Provider Business Practice Location Address
First Line	:	2805 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3332
Country	:	US
Telephone Number	:	177-353-3054
Fax Number	:	177-353-3054

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. JAMALUDIN SITAFALWALLA
Credential	:	B.S. (PHARMACY)
Telephone Number	:	17735330548

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2008

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Directions to “WESTEND PHARMACY ” Practice Location

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