Organization · NPI-2

29 E Madison Corp

Pharmacy, Community/Retail Pharmacy · Chicago, IL

NPI number1497837009
StatusActive
Last updated in NPPESMar 9, 2010

Details

NPI
1497837009
Entity type
Organization (NPI-2)
Legal business name
29 E Madison Corp
Organization subpart
No
Enumeration date
Oct 20, 2006
Last updated
Mar 9, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3336C0003X Pharmacy, Community/Retail Pharmacy054013583ILYes

Other names

  • Ivan T Matthei Pharmacy (Doing Business As)

Practice location

25 E Washington St Lowr 53
Lower Level Pedway
Chicago, IL 60602-1736

Phone 312-263-7194 · Fax 312-263-7636

Mailing address

25 E Washington St Lowr 53
Lower Level Pedway
Chicago, IL 60602-1736

Phone 312-263-7194 · Fax 312-263-7636

Authorized official

Mark Edelheit
Owner
3122637194

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