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General NPI Number Information
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NPI Number | 1881173656
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Entity Type | Organization
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Legal Business Name | INSTARX PHARMACY LLC
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Dates
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Enumeration Date | 08/12/2018
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 18927 HICKORY CREEK DR STE 135
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City | MOKENA
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State | IL
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Zip | 60448
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Country | US
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Telephone | 708-478-0119
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Fax | 708-478-0147
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Provider Business Mailing Address
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Address Line | 18927 HICKORY CREEK DR STE 135
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City | MOKENA
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State | IL
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Zip | 60448-8649
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Country | US
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Telephone | 708-478-0119
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Fax | 708-478-0147
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Authorized Official
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Title or Position | CEO
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Name | BRIAN FITZSIMMONS
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Credential |
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Telephone | 708-478-0119
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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 | 054.020874
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License Number State | IL
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