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General NPI Number Information
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NPI Number | 1245441815
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Entity Type | Organization
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Legal Business Name | THOREK MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 850 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60613-3077
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Country | US
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Telephone | 773-975-3235
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Fax | 773-975-3238
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Provider Business Mailing Address
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Address Line | THOREK HOSPITAL OUTPATIENT PHARMACY 850 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60613
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Country | US
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Telephone | 773-975-3235
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Fax | 773-975-3238
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | JAY DAVID
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Credential | PHARMD
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Telephone | 773-975-3235
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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 | 054017097
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License Number State | IL
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