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General NPI Number Information
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NPI Number | 1790240489
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Entity Type | Organization
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Legal Business Name | ST JUDE PHARMACY, INC.
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 04/12/2019
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Provider Practice Location Address
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Address Line | 301 MADISON ST STE 114
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City | JOLIET
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State | IL
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Zip | 60435-6549
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Country | US
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Telephone | 815-900-9000
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Fax | 815-900-5500
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Provider Business Mailing Address
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Address Line | 301 MADISON ST STE 114
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City | JOLIET
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State | IL
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Zip | 60435-6549
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Country | US
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Telephone | 815-900-9000
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Fax | 815-900-5500
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MOHAMMED J ALAHMED
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Credential | RPH.
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Telephone | 815-900-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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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 #5
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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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