# MEDSHOP INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDICINE STOP OF RIVER FOREST
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689685224
- **Authorized official:** TOM KUKULSKI B.S. (PRESIDENT)
- **Authorized official phone:** (708) 771-6363

## Contact information

- **Practice address:** 7756 MADISON ST, RIVER FOREST, IL 60305-2058
- **Practice address phone:** (708) 771-6363
- **Practice address fax:** (708) 771-6368
- **Mailing address:** 7756 MADISON ST, RIVER FOREST, IL 60305-2058

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054008943 | IL | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 03/26/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1453137 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |