MEDICARE: WEBSTER DRUG 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	183500000X	Pharmacist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1464483	OTHER	IL	PROVIDER NO 3RD PARTY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932225711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEBSTER DRUG INC

Provider Business Mailing Address
First Line	:	610 W 31ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3023
Country	:	US
Telephone Number	:	312-567-1490
Fax Number	:	312-567-0651

Provider Business Practice Location Address
First Line	:	610 W 31ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3023
Country	:	US
Telephone Number	:	312-567-1490
Fax Number	:	312-567-0651

Authorized Official
Title or Position	:	PHARMACIST OWNER
Name	:	MR. MARK ALLEN ROGOWIN
Credential	:	RPH
Telephone Number	:	312-567-1490

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/16/2008

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Directions to “WEBSTER DRUG INC ” Practice Location

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