Healthcare Provider Details

I. General information

NPI: 1043625981
Provider Name (Legal Business Name): JAMES A LOVELL FHCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 GREEN BAY RD BLDG 3452
NORTH CHICAGO IL
60088-3303
US

IV. Provider business mailing address

PO BOX 322 JAMES A LOVELL FHCC
NORTH CHICAGO IL
60064
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-2772
  • Fax: 847-688-2805
Mailing address:
  • Phone: 224-610-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650