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General NPI Number Information
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NPI Number | 1295947430
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Entity Type | Organization
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Legal Business Name | COMMUNITYHEALTH
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2611 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60622-4519
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Country | US
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Telephone | 773-395-9901
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Fax | 773-395-9902
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Provider Business Mailing Address
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Address Line | 2611 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60622-4519
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Country | US
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Telephone | 773-395-9901
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Fax | 773-395-9902
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY OPERATIONS
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Name | TONY BONGIORNO
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Credential | PHARMD
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Telephone | 773-395-9901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State | IL
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