MEDICARE: REMOTE PHARMACY

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	183500000X	Pharmacist		IL

General Provider Information

NPI Number	:	1871602680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REMOTE PHARMACY

Provider Business Mailing Address
First Line	:	2556 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5216
Country	:	US
Telephone Number	:	773-782-0790
Fax Number	:	773-782-0784

Provider Business Practice Location Address
First Line	:	2556 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5216
Country	:	US
Telephone Number	:	773-782-0790
Fax Number	:	773-782-0784

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. ALFREDO VILLASENOR
Credential	:	RPH
Telephone Number	:	773-782-0790

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/21/2022

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Directions to “REMOTE PHARMACY ” Practice Location

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