Healthcare Provider Details

I. General information

NPI: 1952789398
Provider Name (Legal Business Name): AMERICAN CLINICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 W DEVON AVE # STO
CHICAGO IL
60659-1407
US

IV. Provider business mailing address

3101 W DEVON STO
CHICAGO IL
60659
US

V. Phone/Fax

Practice location:
  • Phone: 773-279-5350
  • Fax: 847-754-4991
Mailing address:
  • Phone: 773-279-5350
  • Fax: 847-754-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL B YOUNAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-279-5350