Healthcare Provider Details

I. General information

NPI: 1144593641
Provider Name (Legal Business Name): MARK DRUGS NORTHSHORE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 MILWAUKEE AVE STE 140
DEERFIELD IL
60015-3558
US

IV. Provider business mailing address

1020 MILWAUKEE AVE STE 140
DEERFIELD IL
60015-3558
US

V. Phone/Fax

Practice location:
  • Phone: 847-419-9898
  • Fax: 847-419-9899
Mailing address:
  • Phone: 847-419-9898
  • Fax: 847-419-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.291609
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036.079383
License Number StateIL

VIII. Authorized Official

Name: DR. CRAIG JOSEPH BATOGOWSKI
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 847-419-9898