Healthcare Provider Details

I. General information

NPI: 1730303751
Provider Name (Legal Business Name): PHARMA BIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 197TH ST SUITE 106-4
MOKENA IL
60448-8944
US

IV. Provider business mailing address

9700 WEST 197TH STREET SUITE 106-4
MOKENA IL
60448-8944
US

V. Phone/Fax

Practice location:
  • Phone: 708-339-6200
  • Fax:
Mailing address:
  • Phone: 708-339-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number004-000558
License Number StateIL

VIII. Authorized Official

Name: MR. WILLIAM P REILAND
Title or Position: PRESIDENT
Credential: CPA
Phone: 708-339-6200