Healthcare Provider Details

I. General information

NPI: 1013035781
Provider Name (Legal Business Name): COOK COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-6189
  • Fax: 312-864-9288
Mailing address:
  • Phone: 312-864-6189
  • Fax: 312-864-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number054014914
License Number StateIL

VIII. Authorized Official

Name: JOHN BUSKER
Title or Position: ASSISTANT DIRECTOR OF PHARMACY
Credential:
Phone: 312-864-2194