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General NPI Number Information
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NPI Number | 1225140163
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Entity Type | Organization
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Legal Business Name | UNION HEALTH SERVICE INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 1634 W POLK ST
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City | CHICAGO
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State | IL
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Zip | 60612-4352
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Country | US
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Telephone | 312-423-4260
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Fax | 312-423-4392
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Provider Business Mailing Address
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Address Line | 1634 W POLK ST
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City | CHICAGO
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State | IL
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Zip | 60612-4352
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Country | US
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Telephone | 312-423-4260
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Fax | 312-423-4392
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | GORDON STULL
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Credential | BS PHARMACY
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Telephone | 312-423-4260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number | 054017371
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License Number State | IL
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