Healthcare Provider Details

I. General information

NPI: 1457385775
Provider Name (Legal Business Name): CORE CENTER PHARMACY COOK COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W HARRISON ST
CHICAGO IL
60612-3741
US

IV. Provider business mailing address

2020 W HARRISON ST
CHICAGO IL
60612-3741
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-4880
  • Fax: 312-572-4890
Mailing address:
  • Phone: 312-572-4880
  • Fax: 312-572-4890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number054013985
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LORNA PRYOR
Title or Position: PIC
Credential:
Phone: 312-572-4888