# LOYOLA UNIVERSITY MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MULCAHY PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184789299
- **Authorized official:** LARRY GOLDBERG (PRESIDENT AND CEO)
- **Authorized official phone:** (708) 216-0588

## Contact information

- **Practice address:** 2160 S 1ST AVE, BLDG 107, MAYWOOD, IL 60153-3328
- **Practice address phone:** (708) 216-9100
- **Practice address fax:** (708) 216-1554
- **Mailing address:** 2160 S 1ST AVE, BLDG 107, MAYWOOD, IL 60153-3328
- **Mailing address phone:** (708) 216-9100
- **Mailing address fax:** (708) 216-1554

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054017263 | IL | Yes |

## Other

- **Enumeration date:** 12/27/2006
- **Last updated:** 01/13/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2024686 | PK | — |