Healthcare Provider Details

I. General information

NPI: 1225085350
Provider Name (Legal Business Name): DOUBEK PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 S CICERO AVE
ALSIP IL
60803-2830
US

IV. Provider business mailing address

11350 S CICERO AVE
ALSIP IL
60803-2830
US

V. Phone/Fax

Practice location:
  • Phone: 708-293-1122
  • Fax: 708-293-1144
Mailing address:
  • Phone: 708-293-1122
  • Fax: 708-293-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054003401
License Number StateIL

VIII. Authorized Official

Name: MR. DAVID DOUBEK
Title or Position: OWNER
Credential:
Phone: 708-293-1122