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General NPI Number Information
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NPI Number | 1255485090
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Entity Type | Organization
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Legal Business Name | LUDEMAN HUB PHARMACY
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 114 N ORCHARD DR
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City | PARK FOREST
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State | IL
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Zip | 60466-1200
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Country | US
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Telephone | 708-283-3262
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Fax | 708-283-3188
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Provider Business Mailing Address
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Address Line | 114 N ORCHARD DR
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City | PARK FOREST
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State | IL
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Zip | 60466-1200
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Country | US
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Telephone | 708-283-3262
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Fax | 708-283-3188
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Authorized Official
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Title or Position | PHARMACY SERVICES MANAGER
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Name | MR. ROBERT F HITER
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Credential | RPH
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Telephone | 708-283-3194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 054017311
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License Number State | IL
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