# THOREK MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Thorek Hospital Outpatient Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245441815
- **Authorized official:** JAY DAVID PHARMD (PHARMACIST IN CHARGE)
- **Authorized official phone:** (773) 975-3235

## Contact information

- **Practice address:** 850 W IRVING PARK RD, CHICAGO, IL 60613-3077
- **Practice address phone:** (773) 975-3235
- **Practice address fax:** (773) 975-3238
- **Mailing address:** THOREK HOSPITAL OUTPATIENT PHARMACY, 850 W IRVING PARK RD, CHICAGO, IL 60613
- **Mailing address phone:** (773) 975-3235
- **Mailing address fax:** (773) 975-3238

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054017097 | IL | Yes |

## Other

- **Enumeration date:** 05/25/2007
- **Last updated:** 11/07/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1432981 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |
| 05 | — | 3660000985401 | — | IL |