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General NPI Number Information
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NPI Number | 1972680304
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Entity Type | Organization
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Legal Business Name | PRO-WEST PHARMACY
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3861 W WASHINGTON BLVD
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City | CHICAGO
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State | IL
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Zip | 60624-2342
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Country | US
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Telephone | 773-826-5430
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Fax |
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Provider Business Mailing Address
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Address Line | 3861 W WASHINGTON BLVD
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City | CHICAGO
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State | IL
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Zip | 60624-2342
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Country | US
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Telephone | 773-826-5430
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE MANAGER
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Name | MR. EDWARD FOX
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Credential |
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Telephone | 847-673-2424
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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 | 054-11267
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License Number State | IL
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