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Organization
ILLINOIS DEPARTMENT OF HUMAN
Active
Organization
ILLINOIS DEPARTMENT OF HUMAN
Active
Other names
Shapiro Developmental Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RONDA ANN SUMNER RPH (PHARMACY MANAGER)
(815) 939-8272
Entity
Organization
Contact information
Practice address
100 E JEFFERY ST, KANKAKEE, IL 60901-5018
(815) 939-8272
(815) 939-8274
Mailing address
100 E JEFFERY ST, KANKAKEE, IL 60901-5018
(815) 939-8272
(815) 939-8274
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
054.020222
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023336
PK
—
Enumeration date
01/22/2007
Last updated
07/13/2022
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