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General NPI Number Information
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NPI Number | 1154570208
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Entity Type | Organization
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Legal Business Name | HT OUTPATIENT PHARMACY
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Dates
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Enumeration Date | 09/13/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 3435 W VANBUREN ST
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City | CHICAGO
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State | IL
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Zip | 60624
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Country | US
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Telephone | 773-265-3585
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Fax |
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Provider Business Mailing Address
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Address Line | 51 W STEVENSON DR
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City | GLENDALE HTS
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State | IL
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Zip | 60139-2456
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NEETA TALWAR
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Credential |
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Telephone | 773-265-3724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054016556
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License Number State | IL
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