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General NPI Number Information
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NPI Number | 1891934436
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Entity Type | Organization
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Legal Business Name | SUPERIOR PHARMACY INC
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 356 W SUPERIOR ST
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City | CHICAGO
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State | IL
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Zip | 60654-3416
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Country | US
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Telephone | 312-988-7300
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Fax | 312-988-4600
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Provider Business Mailing Address
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Address Line | 356 W SUPERIOR ST
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City | CHICAGO
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State | IL
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Zip | 60654-3416
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Country | US
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Telephone | 312-988-7300
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Fax | 312-988-4600
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALAN JACKSON
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Credential | MD
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Telephone | 773-619-4102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 054-016533
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License Number State | IL
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