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General NPI Number Information
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NPI Number | 1316470123
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Entity Type | Organization
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Legal Business Name | INTERDEPENDENT PHARMACY, LLC
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 404 N SEYMOUR AVE
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City | MUNDELEIN
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State | IL
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Zip | 60060-1835
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Country | US
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Telephone | 224-475-0020
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Fax | 224-475-0849
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Provider Business Mailing Address
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Address Line | 1778 SOMERSET LN
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City | MUNDELEIN
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State | IL
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Zip | 60060-5363
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Country | US
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Telephone | 224-392-2666
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BYRON STRAKUSEK
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Credential | RPH.
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Telephone | 224-392-2666
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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