MEDICARE: MEDICATE PHARMACY & DME

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	332B00000X	Durable Medical Equipment & Medical Supplies	203000739	IL

General Provider Information

NPI Number	:	1720027550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICATE PHARMACY & DME

Provider Business Mailing Address
First Line	:	911 WATER ST
Second Line	:
City	:	CAHOKIA
State	:	IL
Zip	:	62206-1614
Country	:	US
Telephone Number	:	618-482-2002
Fax Number	:	618-215-0653

Provider Business Practice Location Address
First Line	:	911 WATER ST
Second Line	:
City	:	CAHOKIA
State	:	IL
Zip	:	62206-1614
Country	:	US
Telephone Number	:	618-482-2002
Fax Number	:	618-215-0653

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL LEE SCHALTENBRAND
Credential	:	R.PH.
Telephone Number	:	618-875-1000

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	01/16/2013

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