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General NPI Number Information
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NPI Number | 1013520113
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Entity Type | Organization
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Legal Business Name | PMR ILLINOIS HOLDING, LLC
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 600 E SIBLEY BLVD
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City | DOLTON
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State | IL
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Zip | 60419-2599
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Country | US
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Telephone | 708-340-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 1395 NW 167TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-5710
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Country | US
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Telephone | 305-628-6117
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MARY CHEN
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Credential |
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Telephone | 305-831-4722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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