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Organization
PETERSONS PERSCRIPTION PHARMACY INC
Active
Organization
PETERSONS PERSCRIPTION PHARMACY INC
Active
Other names
PETERSONS PRESCRIPTION PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM ELICH RPH (PRESIDENT)
(708) 868-5020
Entity
Organization
Contact information
Practice address
715 LAKE ST, OAK PARK, IL 60301-1467
(708) 848-5020
(708) 848-5022
Mailing address
715 LAKE ST, OAK PARK, IL 60301-1467
(708) 848-5020
(708) 848-5022
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054010011
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1459800
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
367728439001
—
IL
Enumeration date
08/10/2006
Last updated
08/31/2012
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