Provider Demographics
NPI:1558432914
Name:TARPEY PHARMACY
Entity Type:Organization
Organization Name:TARPEY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:TARPEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-545-0500
Mailing Address - Street 1:5933 N. CICERO AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5701
Mailing Address - Country:US
Mailing Address - Phone:773-545-0500
Mailing Address - Fax:773-545-9062
Practice Address - Street 1:5933 N. CICERO AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5701
Practice Address - Country:US
Practice Address - Phone:773-545-0500
Practice Address - Fax:773-545-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540050093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid