Provider Demographics
NPI:1447668934
Name:TOWNCARE PHARMACY LLC
Entity type:Organization
Organization Name:TOWNCARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIKE
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:708-388-2329
Mailing Address - Street 1:13805 CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60418-1826
Mailing Address - Country:US
Mailing Address - Phone:708-388-2329
Mailing Address - Fax:708-388-2328
Practice Address - Street 1:13805 CICERO AVE
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60418-1826
Practice Address - Country:US
Practice Address - Phone:708-388-2329
Practice Address - Fax:708-388-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336S0011X
IL054.0185733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147143OtherPK
IL=========-60445-01Medicaid
IL=========6044501Medicaid