# CONNEYS ELM STREET PHARMACY INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538174149
- **Authorized official:** MR. MARK JACOBS (PHARMACIST AND OWNER)
- **Authorized official phone:** (847) 446-0032

## Contact information

- **Practice address:** 736 ELM ST, WINNETKA, IL 60093-2506
- **Practice address phone:** (847) 446-3335
- **Practice address fax:** (847) 446-1574
- **Mailing address:** 736 ELM ST, WINNETKA, IL 60093-2506
- **Mailing address phone:** (847) 446-0032
- **Mailing address fax:** (847) 446-1574

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054013973 | IL | Yes |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 12/06/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1428564 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |