Healthcare Provider Details

I. General information

NPI: 1669525549
Provider Name (Legal Business Name): MADDEN MENTAL HEALTH PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S. 1ST AVE
HINES IL
60141-7000
US

IV. Provider business mailing address

1200 S. 1ST AVE
HINES IL
60141-7000
US

V. Phone/Fax

Practice location:
  • Phone: 708-338-7319
  • Fax: 708-338-7088
Mailing address:
  • Phone: 708-338-7319
  • Fax: 708-338-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number058.013487
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDRA ALVARADO
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 708-338-7319