MEDICARE: NORTH STAR 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	054009801	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2020280	OTHER		PK

General Provider Information

NPI Number	:	1902972003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH STAR PHARMACY INC

Provider Business Mailing Address
First Line	:	2123 E 71ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2103
Country	:	US
Telephone Number	:	773-493-7733
Fax Number	:	773-493-7734

Provider Business Practice Location Address
First Line	:	2123 E 71ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2103
Country	:	US
Telephone Number	:	773-493-7733
Fax Number	:	773-493-7734

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NALIN SHAH
Credential	:	BS IN PHARMACY
Telephone Number	:	773-493-7733

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	11/18/2016

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