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General NPI Number Information
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NPI Number | 1861906067
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Entity Type | Organization
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Legal Business Name | PDI MEDICAL III LLC
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 11/27/2017
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Provider Practice Location Address
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Address Line | 1623 BARCLAY BOULEVARD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089
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Country | US
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Telephone | 224-436-1634
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Fax |
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Provider Business Mailing Address
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Address Line | 1623 BARCLAY BLVD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-4544
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Country | US
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Telephone | 224-436-1634
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JOSEPH FRIEDMAN
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Credential | RPH
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Telephone | 224-377-9734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 051-032295
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License Number State | IL
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