# MEDICATE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871086082
- **Authorized official:** MICHAEL LEE SCHALTENBRAND (PRESIDENT)
- **Authorized official phone:** (618) 875-1000

## Contact information

- **Practice address:** 5869 BOND AVE, CENTREVILLE, IL 62207-2300
- **Practice address phone:** (618) 857-2608
- **Practice address fax:** (618) 857-2610
- **Mailing address:** 1833 KINGSHIGHWAY, WASHINGTON PARK, IL 62204
- **Mailing address phone:** (618) 874-3000
- **Mailing address fax:** (618) 874-3103

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054-018736 | IL | Yes |

## Other

- **Enumeration date:** 06/12/2018
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 054-018736 | ILLINOIS PHARMACY LICENSE NUMBER | IL |
| 01 | — | CO014205 | CONTROLLED SUBSTANCE LICENSE NUMBER | IL |