Healthcare Provider Details

I. General information

NPI: 1861906067
Provider Name (Legal Business Name): PDI MEDICAL III LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 BARCLAY BOULEVARD
BUFFALO GROVE IL
60089
US

IV. Provider business mailing address

1623 BARCLAY BLVD
BUFFALO GROVE IL
60089-4544
US

V. Phone/Fax

Practice location:
  • Phone: 224-436-1634
  • Fax:
Mailing address:
  • Phone: 224-436-1634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number051-032295
License Number StateIL

VIII. Authorized Official

Name: JOSEPH FRIEDMAN
Title or Position: COO
Credential: RPH
Phone: 224-377-9734