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General NPI Number Information
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NPI Number | 1497837009
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Entity Type | Organization
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Legal Business Name | 29 E MADISON CORP
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST LOWR 53 LOWER LEVEL PEDWAY
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City | CHICAGO
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State | IL
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Zip | 60602-1736
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Country | US
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Telephone | 312-263-7194
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Fax | 312-263-7636
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Provider Business Mailing Address
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Address Line | 25 E WASHINGTON ST LOWR 53 LOWER LEVEL PEDWAY
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City | CHICAGO
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State | IL
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Zip | 60602-1736
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Country | US
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Telephone | 312-263-7194
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Fax | 312-263-7636
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Authorized Official
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Title or Position | OWNER
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Name | MARK EDELHEIT
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Credential | RPH
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Telephone | 312-263-7194
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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 | 054013583
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License Number State | IL
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