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General NPI Number Information
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NPI Number | 1730854621
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Entity Type | Organization
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Legal Business Name | PROMEDIX LLC
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 2649 N LARAMIE AVE STE P1
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City | CHICAGO
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State | IL
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Zip | 60639-1613
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Country | US
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Telephone | 773-248-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 2649 N LARAMIE AVE STE P1
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City | CHICAGO
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State | IL
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Zip | 60639-1613
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Country | US
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Telephone | 773-248-3200
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Fax |
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Authorized Official
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Title or Position | PIC
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Name | DR. ARASH RAEI
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Credential | PHARMD
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Telephone | 773-248-3200
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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 |
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License Number State |
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