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NPI Code Detail

MEDICARE: MEDIDERM INC.

MEDICARE: MEDIDERM INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy054013136IL

General Provider Information

NPI Number : 1033389374
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDIDERM INC.
Provider Business Mailing Address
First Line : PO BOX 1535
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-7535
Country : US
Telephone Number : 847-966-3192
Fax Number : 847-966-5046
Provider Business Practice Location Address
First Line : 650 W LAKE COOK RD STE 150
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-2082
Country : US
Telephone Number : 800-966-0670
Fax Number : 800-965-3180
Authorized Official
Title or Position : OWNER
Name : MISS LAUREL LINTON
Credential :
Telephone Number : 800-966-0670
Provider Enumeration Date : 03/03/2008
Last Update Date : 01/27/2016

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