Provider Demographics
NPI:1720027550
Name:MEDICATE PHARMACY & DME
Entity Type:Organization
Organization Name:MEDICATE PHARMACY & DME
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 1:911 WATER ST
Mailing Address - Street 2:
Mailing Address - City:CAHOKIA
Mailing Address - State:IL
Mailing Address - Zip Code:62206-1614
Mailing Address - Country:US
Mailing Address - Phone:618-482-2002
Mailing Address - Fax:618-215-0653
Practice Address - Street 1:911 WATER ST
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-1614
Practice Address - Country:US
Practice Address - Phone:618-482-2002
Practice Address - Fax:618-215-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000739332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies