# MASCOT PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDICINE SHOPPE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144385576
- **Authorized official:** MARIA L COSTA RPH (OWNER PHARMACIST)
- **Authorized official phone:** (847) 698-3323

## Contact information

- **Practice address:** 110 MAIN ST, PARK RIDGE, IL 60068-4030
- **Practice address phone:** (847) 698-3323
- **Practice address fax:** (847) 698-4112
- **Mailing address:** 110 MAIN ST, PARK RIDGE, IL 60068-4030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336L0003X | Long Term Care Pharmacy | 054014403 | IL | — |

## Other

- **Enumeration date:** 12/26/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1425950 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |