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General NPI Number Information
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NPI Number | 1619417979
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Entity Type | Organization
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Legal Business Name | ROSELAND COMMUNITY HOSPITAL ASSOCIATION
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 05/26/2017
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Provider Practice Location Address
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Address Line | 45 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-4200
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Country | US
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Telephone | 773-291-1684
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Fax | 773-291-1685
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Provider Business Mailing Address
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Address Line | 45 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-4200
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Country | US
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Telephone | 773-291-1684
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Fax | 773-291-1685
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Authorized Official
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Title or Position | CFO, AO
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Name | MARLO KEMP
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Credential | RPH
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Telephone | 773-995-6502
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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 | 054020279
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License Number State | IL
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