MEDICARE: EAST CALUMET HEALTH SERVICES 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	183500000X	Pharmacist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1478571	OTHER	IL	NCPDP

General Provider Information

NPI Number	:	1588785935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST CALUMET HEALTH SERVICES INC.

Provider Business Mailing Address
First Line	:	335 E 51ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-3510
Country	:	US
Telephone Number	:	773-624-4925
Fax Number	:	773-624-0991

Provider Business Practice Location Address
First Line	:	335 E 51ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-3510
Country	:	US
Telephone Number	:	773-624-4925
Fax Number	:	773-624-0991

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. RAVINDER SETHI
Credential	:
Telephone Number	:	773-624-4925

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/22/2020

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