Healthcare Provider Details

I. General information

NPI: 1518993203
Provider Name (Legal Business Name): ONCOLOGY SPECIALISTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LUTHER LN
PARK RIDGE IL
60068-1270
US

IV. Provider business mailing address

PO BOX 736
PARK RIDGE IL
60068-0736
US

V. Phone/Fax

Practice location:
  • Phone: 847-268-8200
  • Fax: 847-723-8003
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number336012509
License Number StateIL

VIII. Authorized Official

Name: SONYA N MODI
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 847-268-8200