MEDICARE: AMBROSE 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
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1414236	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1558437657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBROSE PHARMACY INC

Provider Business Mailing Address
First Line	:	3534 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3534 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3912
Country	:	US
Telephone Number	:	773-762-8892
Fax Number	:	773-762-8760

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENNIS AMBROSE
Credential	:	RPH
Telephone Number	:	773-762-8892

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	09/11/2025

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