MEDICARE: MERZ APOTHECARY, 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		IL

General Provider Information

NPI Number	:	1851458848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERZ APOTHECARY, INC

Provider Business Mailing Address
First Line	:	4716 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2010
Country	:	US
Telephone Number	:	773-989-0900
Fax Number	:	773-989-8108

Provider Business Practice Location Address
First Line	:	4716 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2010
Country	:	US
Telephone Number	:	773-989-0900
Fax Number	:	773-989-8108

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ABDUL QAIYUM
Credential	:	R.PH.
Telephone Number	:	773-989-0900

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/22/2020

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