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General NPI Number Information
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NPI Number | 1942416938
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Entity Type | Organization
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Legal Business Name | 47TH AND VICENNES PROFESSIONAL
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 504 E 47TH ST
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City | CHICAGO
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State | IL
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Zip | 60653-4208
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Country | US
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Telephone | 773-624-0613
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Fax | 773-624-0204
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Provider Business Mailing Address
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Address Line | 504 - 506 E 47TH ST
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City | CHICAGO
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State | IL
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Zip | 60653-4208
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Country | US
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Telephone | 773-624-0613
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Fax | 773-624-0204
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Authorized Official
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Title or Position | PHARMCIST
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Name | ZAROOQ SABAYO
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Credential |
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Telephone | 773-624-0613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 054014942
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License Number State | IL
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