Healthcare Provider Details

I. General information

NPI: 1215955802
Provider Name (Legal Business Name): COOK COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 S CICERO AVE
OAK FOREST IL
60452
US

IV. Provider business mailing address

15900 S CICERO AVE
OAK FOREST IL
60452
US

V. Phone/Fax

Practice location:
  • Phone: 708-633-3708
  • Fax: 708-633-2295
Mailing address:
  • Phone: 708-633-3708
  • Fax: 708-633-2295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number054.017287
License Number StateIL

VIII. Authorized Official

Name: JUDILYNN BULT
Title or Position: COOK COUNTY HEALTH & HOSPITAL
Credential:
Phone: 708-633-4437