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NPI Code Detail

MEDICARE: CARTAGENA PHARMACY INC

MEDICARE: CARTAGENA 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
13336M0003XManaged Care Organization Pharmacy
23336C0002XClinic PharmacyIL05411448IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11463342OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
21463342OTHEROTHER ID NUMBER

General Provider Information

NPI Number : 1902934268
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARTAGENA PHARMACY INC
Provider Business Mailing Address
First Line : 1505 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1313
Country : US
Telephone Number : 773-274-7885
Fax Number : 773-274-7906
Provider Business Practice Location Address
First Line : 1505 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1313
Country : US
Telephone Number : 773-274-7885
Fax Number : 773-274-7906
Authorized Official
Title or Position : PHARMACIST IN CHARGE
Name : RONALD KIELAR
Credential :
Telephone Number : 773-274-7885
Provider Enumeration Date : 03/01/2007
Last Update Date : 02/22/2011

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Directions to “CARTAGENA PHARMACY INC ” Practice Location

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