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NPI Code Detail

MEDICARE: TRI STAR PHARMACY INC

MEDICARE: TRI STAR 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
13336C0002XClinic Pharmacy5416229IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11481059OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1518157528
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRI STAR PHARMACY INC
Provider Business Mailing Address
First Line : 5310 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2514
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5310 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2514
Country : US
Telephone Number : 773-334-9646
Fax Number : 773-334-9648
Authorized Official
Title or Position : PHARMACIST
Name : KATIE LINDSEY
Credential :
Telephone Number : 773-334-9646
Provider Enumeration Date : 07/26/2007
Last Update Date : 04/02/2009

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Directions to “TRI STAR PHARMACY INC ” Practice Location

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