MEDICARE: OAK FOREST HOSPITAL PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336I0012X	Institutional Pharmacy	AJ4100171	IL

General Provider Information

NPI Number	:	1205854866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK FOREST HOSPITAL PHARMACY

Provider Business Mailing Address
First Line	:	15900 CICERO AVENUE
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-4006
Country	:	US
Telephone Number	:	708-633-4437
Fax Number	:	708-633-4442

Provider Business Practice Location Address
First Line	:	15900 CICERO AVENUE
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-4006
Country	:	US
Telephone Number	:	708-633-4437
Fax Number	:	708-633-4442

Authorized Official
Title or Position	:	PHARMACY DIRECTOR
Name	:	MR. MARTIN GRANT
Credential	:	RPH
Telephone Number	:	708-633-4437

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/22/2020

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