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General NPI Number Information
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NPI Number | 1710269022
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Entity Type | Organization
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Legal Business Name | 900 PHARMACY LLC
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 4527 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60640-5608
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Country | US
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Telephone | 773-907-9009
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Fax | 773-907-9001
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Provider Business Mailing Address
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Address Line | 4527 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60640-5608
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Country | US
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Telephone | 773-907-9009
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Fax | 773-907-9001
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Authorized Official
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Title or Position | OFFICER
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Name | VALENCIA WILSON
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Credential |
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Telephone | 773-907-9007
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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 | 054017733
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License Number State | IL
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