MEDICARE: M1VM

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1508711748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M1VM

Provider Business Mailing Address
First Line	:	10402 S 84TH AVE
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-1704
Country	:	US
Telephone Number	:	754-778-2976
Fax Number	:

Provider Business Practice Location Address
First Line	:	2527 CHURCH AVE APT 1B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4570
Country	:	US
Telephone Number	:	754-778-2976
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KAREEM J MCRAE
Credential	:
Telephone Number	:	754-778-2976

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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