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General NPI Number Information
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NPI Number | 1740767409
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Entity Type | Organization
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Legal Business Name | BALSAM PHARMACY
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 1167 E ALGONQUIN RD STE 2
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City | DES PLAINES
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State | IL
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Zip | 60016-6325
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Country | US
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Telephone | 847-257-7448
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Fax |
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Provider Business Mailing Address
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Address Line | 1167 E ALGONQUIN RD STE 2
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City | DES PLAINES
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State | IL
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Zip | 60016-6325
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Country | US
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Telephone | 847-257-7448
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | YOUSEF ARMAN
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Credential |
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Telephone | 847-257-7448
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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 | 054.020662
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License Number State | IL
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