MEDICARE: NORTHTOWN DRUGS

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		IL

General Provider Information

NPI Number	:	1871633578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHTOWN DRUGS

Provider Business Mailing Address
First Line	:	2158 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2127
Country	:	US
Telephone Number	:	773-743-0887
Fax Number	:	773-743-0797

Provider Business Practice Location Address
First Line	:	2158 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2127
Country	:	US
Telephone Number	:	773-743-0887
Fax Number	:	773-743-0797

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MICHAEL NELSON
Credential	:	R.PH
Telephone Number	:	773-743-0887

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

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