Healthcare Provider Details

I. General information

NPI: 1447959937
Provider Name (Legal Business Name): ASHLAND HEALTH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N CATHERINE AVE
LA GRANGE IL
60525-5930
US

IV. Provider business mailing address

12 N CATHERINE AVE
LA GRANGE IL
60525-5930
US

V. Phone/Fax

Practice location:
  • Phone: 708-482-4000
  • Fax: 708-482-4004
Mailing address:
  • Phone: 708-482-4000
  • Fax: 708-482-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESSICA DANGLER
Title or Position: PIC/DIRECTOR OF PHARMACY
Credential: PHARM D
Phone: 708-482-4000