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Organization
CPTL HOME PHARMACY INC
Active
Organization
CPTL HOME PHARMACY INC
Active
Other names
CPTL Home Pharmacy, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
EVANGELINE COOPER (PRESIDENT)
(312) 262-4520
Entity
Organization
Contact information
Practice address
1410 W FULTON ST, SUITE 201, CHICAGO, IL 60607-1110
(312) 262-4520
(312) 262-4531
Mailing address
1410 W FULTON ST, SUITE 201, CHICAGO, IL 60607-1110
(312) 262-4520
(312) 262-4531
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054017577
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1485209
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/16/2010
Last updated
12/28/2010
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