Organization · NPI-2

111th Pharma - Family

Pharmacy, Community/Retail Pharmacy · Chicago, IL

NPI number1255415386
StatusActive
Last updated in NPPESAug 27, 2013

Details

NPI
1255415386
Entity type
Organization (NPI-2)
Legal business name
111th Pharma - Family
Organization subpart
No
Enumeration date
Oct 25, 2006
Last updated
Aug 27, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3336C0003X Pharmacy, Community/Retail Pharmacy054018137ILYes

Other names

  • 111th Pharma Family (Doing Business As)

Practice location

11101 S State St
Chicago, IL 60628-4206

Phone 773-785-5192 · Fax 773-821-6970

Mailing address

11101 S State St
Chicago, IL 60628-4206

Phone 773-785-5192 · Fax 773-821-6970

Authorized official

Adele Vanjackson
Pic
7737855192

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