Organization
MEDICATE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL LEE SCHALTENBRAND (PRESIDENT)
(618) 875-1000
Entity
Organization
Contact information
Practice address
5869 BOND AVE, CENTREVILLE, IL 62207-2300
(618) 857-2608
(618) 857-2610
Mailing address
1833 KINGSHIGHWAY, WASHINGTON PARK, IL 62204
(618) 874-3000
(618) 874-3103
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054-018736
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054-018736
ILLINOIS PHARMACY LICENSE NUMBER
IL
01
—
CO014205
CONTROLLED SUBSTANCE LICENSE NUMBER
IL
Enumeration date
06/12/2018
Last updated
03/07/2023
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