MEDICARE: PILL SHOP 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	3336C0004X	Compounding Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	054.018224	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2139415	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588906507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PILL SHOP PHARMACY INC

Provider Business Mailing Address
First Line	:	3535 E NEW YORK ST STE 117
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-4466
Country	:	US
Telephone Number	:	630-618-2048
Fax Number	:	630-618-2394

Provider Business Practice Location Address
First Line	:	3535 E NEW YORK ST STE 117
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-4466
Country	:	US
Telephone Number	:	630-618-2048
Fax Number	:	630-618-2394

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANTOINE MOURANI
Credential	:
Telephone Number	:	312-659-3588

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	05/18/2015

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Directions to “PILL SHOP PHARMACY INC ” Practice Location

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