Healthcare Provider Details

I. General information

NPI: 1912523564
Provider Name (Legal Business Name): MALE-ORDER MEN'S HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N. DEARBORN ST.
CHICAGO IL
60654
US

IV. Provider business mailing address

710 N. DEARBORN ST.
CHICAGO IL
60654
US

V. Phone/Fax

Practice location:
  • Phone: 800-420-6927
  • Fax: 800-420-6927
Mailing address:
  • Phone: 800-420-6927
  • Fax: 800-420-6927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FEDJA TEMIM
Title or Position: MANAGER
Credential: PHARMD
Phone: 800-420-6927