Provider Demographics
NPI:1407244502
Name:MEDICATE PHARMACY INC
Entity Type:Organization
Organization Name:MEDICATE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHALTENBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-875-1000
Mailing Address - Street 1:2166 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4700
Mailing Address - Country:US
Mailing Address - Phone:618-875-1000
Mailing Address - Fax:618-875-8912
Practice Address - Street 1:2166 MADISON AVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4700
Practice Address - Country:US
Practice Address - Phone:618-875-1000
Practice Address - Fax:618-875-8912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICATE PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy