Healthcare Provider Details

I. General information

NPI: 1033384003
Provider Name (Legal Business Name): ROOTS PHARMACY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 RAND RD STE 101
DES PLAINES IL
60016-2352
US

IV. Provider business mailing address

960 RAND RD STE 101
DES PLAINES IL
60016-2352
US

V. Phone/Fax

Practice location:
  • Phone: 847-827-1900
  • Fax: 847-827-3600
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054016414
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KYLE RORTSART
Title or Position: PRESIDENT
Credential:
Phone: 801-885-5959