MEDICARE: G.A.PHARMACY

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	054014818	IL

General Provider Information

NPI Number	:	1962452417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G.A.PHARMACY

Provider Business Mailing Address
First Line	:	7036 W. CERMAK RD
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-2197
Country	:	US
Telephone Number	:	708-788-3166
Fax Number	:	708-788-3181

Provider Business Practice Location Address
First Line	:	7036 CERMAK RD
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-2197
Country	:	US
Telephone Number	:	708-788-3166
Fax Number	:	708-788-3181

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	DR. MAHENDRA C PATEL
Credential	:	PHARM.D
Telephone Number	:	708-788-3166

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/21/2008

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