Healthcare Provider Details

I. General information

NPI: 1043486269
Provider Name (Legal Business Name): MARK DRUGS NORTHSHORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 MILWAUKEE AVE STE 140
DEERFIELD IL
60015-3513
US

IV. Provider business mailing address

1020 MILWAUKEE AVE STE 140
DEERFIELD IL
60015-3513
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054016368
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CRAIG BATOGOWSKI
Title or Position: OWNER
Credential: PHRMD
Phone: 630-699-2164