MEDICARE: MEDICATE 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	054014315	IL

General Provider Information

NPI Number	:	1841245404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICATE PHARMACY INC

Provider Business Mailing Address
First Line	:	1833 KINGSHIGHWAY
Second Line	:
City	:	WASHINGTON PARK
State	:	IL
Zip	:	62204-2135
Country	:	US
Telephone Number	:	618-874-3000
Fax Number	:	618-874-3103

Provider Business Practice Location Address
First Line	:	1833 KINGSHIGHWAY
Second Line	:
City	:	WASHINGTON PARK
State	:	IL
Zip	:	62204-2135
Country	:	US
Telephone Number	:	618-874-3000
Fax Number	:	618-874-3103

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL LEE SCHALTENBRAND
Credential	:	R.PH.
Telephone Number	:	618-874-3000

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	08/08/2011

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Directions to “MEDICATE PHARMACY INC ” Practice Location

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