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General NPI Number Information
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NPI Number | 1265509087
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Entity Type | Organization
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Legal Business Name | RESURRECTION SERVICES
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1111 SUPERIOR ST SUITE 103
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City | MELROSE PARK
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State | IL
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Zip | 60160-4138
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Country | US
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Telephone | 708-938-7213
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Fax | 708-681-6178
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Provider Business Mailing Address
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Address Line | 1111 SUPERIOR ST SUITE 103
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City | MELROSE PARK
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State | IL
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Zip | 60160-4138
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Country | US
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Telephone | 708-938-7213
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Fax | 708-681-6178
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | USMA KHAN
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Credential | PHARMD
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Telephone | 708-938-7213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State | IL
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