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General NPI Number Information
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NPI Number | 1912523564
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Entity Type | Organization
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Legal Business Name | MALE-ORDER MEN'S HEALTH LLC
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 710 N. DEARBORN ST.
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 800-420-6927
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Fax | 800-420-6927
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Provider Business Mailing Address
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Address Line | 710 N. DEARBORN ST.
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 800-420-6927
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Fax | 800-420-6927
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Authorized Official
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Title or Position | MANAGER
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Name | FEDJA TEMIM
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Credential | PHARMD
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Telephone | 800-420-6927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order 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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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