Healthcare Provider Details

I. General information

NPI: 1538142385
Provider Name (Legal Business Name): HARVEY NADICK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5364 W DEVON AVE
CHICAGO IL
60646-4143
US

IV. Provider business mailing address

5364 W DEVON AVE
CHICAGO IL
60646-4143
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-6090
  • Fax: 773-774-7677
Mailing address:
  • Phone: 773-774-6090
  • Fax: 773-774-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51-027247
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54006620
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: