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NPI Code Detail

MEDICARE: K AND S PHARMACY INC

MEDICARE: K AND S 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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy54005470IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11434618OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1558424176
Entity Type Code : Organization
Provider Name (Legal Business Name) : K AND S PHARMACY INC
Provider Business Mailing Address
First Line : 4017 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4605
Country : US
Telephone Number : 773-585-3356
Fax Number : 773-585-5746
Provider Business Practice Location Address
First Line : 4017 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4605
Country : US
Telephone Number : 773-585-3356
Fax Number : 773-585-5746
Authorized Official
Title or Position : PIC AND PRES
Name : BABULAL BHORANIA
Credential : RPH
Telephone Number : 773-585-3356
Provider Enumeration Date : 12/18/2006
Last Update Date : 05/04/2010

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Directions to “K AND S PHARMACY INC ” Practice Location

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