# 900 PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** 900 PHARMACY LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710269022
- **Authorized official:** VALENCIA WILSON (OFFICER)
- **Authorized official phone:** (773) 907-9007

## Contact information

- **Practice address:** 4527 N SHERIDAN RD, CHICAGO, IL 60640-5608
- **Practice address phone:** (773) 907-9009
- **Practice address fax:** (773) 907-9001
- **Mailing address:** 4527 N SHERIDAN RD, CHICAGO, IL 60640-5608
- **Mailing address phone:** (773) 907-9009
- **Mailing address fax:** (773) 907-9001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054017733 | IL | Yes |

## Other

- **Enumeration date:** 09/13/2011
- **Last updated:** 10/14/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1486011 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |