MEDICARE: PHARMACY CENTER 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	333600000X	Pharmacy	054-014023	IL

General Provider Information

NPI Number	:	1598760902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY CENTER INC.

Provider Business Mailing Address
First Line	:	101 W MARKET ST
Second Line	:
City	:	MOUNT CARROLL
State	:	IL
Zip	:	61053-1031
Country	:	US
Telephone Number	:	815-244-2171
Fax Number	:	815-244-1174

Provider Business Practice Location Address
First Line	:	101 W MARKET ST
Second Line	:
City	:	MOUNT CARROLL
State	:	IL
Zip	:	61053-1031
Country	:	US
Telephone Number	:	815-244-2171
Fax Number	:	815-244-1174

Authorized Official
Title or Position	:	PRESIDENT/PHARMACIST
Name	:	JOHN ALLAN HUTCHISON
Credential	:	R.PH.
Telephone Number	:	815-244-2171

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	01/27/2012

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