MEDICARE: OSCO 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	261Q00000X	Clinic/Center	051.297138	IL

General Provider Information

NPI Number	:	1457781445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSCO PHARMACY

Provider Business Mailing Address
First Line	:	2633 W FARRAGUT AVE APT 1E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3326
Country	:	US
Telephone Number	:	773-865-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	2633 W FARRAGUT AVE APT 1E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3326
Country	:	US
Telephone Number	:	773-865-2776
Fax Number	:

Authorized Official
Title or Position	:	PHARMD
Name	:	DR. GWEN HOANG PHAM
Credential	:
Telephone Number	:	773-865-2776

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	11/13/2013

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