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General NPI Number Information
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NPI Number | 1922485077
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Entity Type | Organization
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Legal Business Name | GOOD HEALTH PHARMACY
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 1999 SPRINGBROOK SQUARE DR UNIT 105
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City | NAPERVILLE
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State | IL
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Zip | 60564-5946
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Country | US
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Telephone | 630-210-8995
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Fax |
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Provider Business Mailing Address
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Address Line | 3919 CALLANDER CT
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City | NAPERVILLE
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State | IL
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Zip | 60564-8306
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Country | US
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Telephone | 724-799-6098
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | OLUYEMISI IJOSE
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Credential |
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Telephone | 724-799-6098
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054018782
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License Number State | IL
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