=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730286006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONDELL MEDICAL CENTER HOME PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28835 N HERKY DR SUITE 101
-----------------------------------------------------
City | LAKE BLUFF
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60044-1464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-680-0688
-----------------------------------------------------
Fax | 847-680-0692
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 W CHURCH ST
-----------------------------------------------------
City | LIBERTYVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60048-2149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-816-7717
-----------------------------------------------------
Fax | 847-367-9078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. LINDA M KRITIKOS
-----------------------------------------------------
Credential | RN,BSN,MPH
-----------------------------------------------------
Telephone | 847-816-7717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------