MEDICARE: WELL FUTURE PHARMACY LLC

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	3336C0003X	Community/Retail Pharmacy	054017943	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2135734	OTHER		PK

General Provider Information

NPI Number	:	1972866135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELL FUTURE PHARMACY LLC

Provider Business Mailing Address
First Line	:	122 W 146TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-3802
Country	:	US
Telephone Number	:	888-685-9515
Fax Number	:	646-934-6409

Provider Business Practice Location Address
First Line	:	661 N WELLS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-3616
Country	:	US
Telephone Number	:	312-589-7620
Fax Number	:	312-589-7621

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	ERIC KINARIWALA
Credential	:
Telephone Number	:	888-685-9515

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	09/06/2022

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