=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881065480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSTANTPHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2015
-----------------------------------------------------
Last Update Date | 04/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21000 S FRANKFORT SQUARE RD SUITE M
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60423-9385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-534-5813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22048 EMILY LN
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60423-7816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. OPEYEMI OYELAHAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-978-5514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 054018870
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------