Provider Demographics
NPI:1720436496
Name:OSCO
Entity type:Organization
Organization Name:OSCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHWALEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-348-8079
Mailing Address - Street 1:6732 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2358
Mailing Address - Country:US
Mailing Address - Phone:847-967-1382
Mailing Address - Fax:
Practice Address - Street 1:2550 CLYBOURN ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1941
Practice Address - Country:US
Practice Address - Phone:773-348-8079
Practice Address - Fax:773-348-8203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFEWAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051027181146M00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty