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Organization
CONNEYS ELM STREET PHARMACY INC
Active
Organization
CONNEYS ELM STREET PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK JACOBS (PHARMACIST AND OWNER)
(847) 446-0032
Entity
Organization
Contact information
Practice address
736 ELM ST, WINNETKA, IL 60093-2506
(847) 446-3335
(847) 446-1574
Mailing address
736 ELM ST, WINNETKA, IL 60093-2506
(847) 446-0032
(847) 446-1574
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054013973
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1428564
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/30/2006
Last updated
12/06/2011
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