MEDICARE: ALBANY 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	332B00000X	Durable Medical Equipment & Medical Supplies	054009946	IL
2	3336C0003X	Community/Retail Pharmacy	054009946	IL

General Provider Information

NPI Number	:	1881846343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBANY PHARMACY INC.

Provider Business Mailing Address
First Line	:	8850 N MILWAUKEE AVE
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-1735
Country	:	US
Telephone Number	:	847-699-1500
Fax Number	:	847-699-1515

Provider Business Practice Location Address
First Line	:	8850 N MILWAUKEE AVE
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-1735
Country	:	US
Telephone Number	:	847-699-1500
Fax Number	:	847-699-1515

Authorized Official
Title or Position	:	PHARMACIST, PRESIDENT OF COMPANY
Name	:	MR. MICHAEL YOUNG LEE
Credential	:
Telephone Number	:	847-699-1500

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	11/27/2013

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