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General NPI Number Information
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NPI Number | 1518993203
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Entity Type | Organization
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Legal Business Name | ONCOLOGY SPECIALISTS SC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 1700 LUTHER LN
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City | PARK RIDGE
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State | IL
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Zip | 60068-1270
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Country | US
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Telephone | 847-268-8200
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Fax | 847-723-8003
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Provider Business Mailing Address
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Address Line | PO BOX 736
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City | PARK RIDGE
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State | IL
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Zip | 60068-0736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | SONYA N MODI
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Credential | PHARMD
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Telephone | 847-268-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 336012509
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License Number State | IL
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