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Organization
29 E MADISON CORP
Active
Organization
29 E MADISON CORP
Active
Other names
IVAN T MATTHEI PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK EDELHEIT RPH (OWNER)
(312) 263-7194
Entity
Organization
Contact information
Practice address
25 E WASHINGTON ST LOWR 53, LOWER LEVEL PEDWAY, CHICAGO, IL 60602-1736
(312) 263-7194
(312) 263-7636
Mailing address
25 E WASHINGTON ST LOWR 53, LOWER LEVEL PEDWAY, CHICAGO, IL 60602-1736
(312) 263-7194
(312) 263-7636
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054013583
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1449948
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
6060201
—
IL
Enumeration date
10/20/2006
Last updated
03/09/2010
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