# MEDCENTRIX INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** INGALLS PROFESSIONAL PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912057027
- **Authorized official:** JULIE WITVOET (PHARMACY MANAGER)
- **Authorized official phone:** (708) 915-4306

## Contact information

- **Practice address:** 71 W 156TH ST, SUITE 104, HARVEY, IL 60426-4260
- **Practice address phone:** (708) 915-4306
- **Practice address fax:** (708) 915-2095
- **Mailing address:** 71 W 156TH ST, SUITE 104, HARVEY, IL 60426-4260
- **Mailing address phone:** (708) 915-4306
- **Mailing address fax:** (708) 915-2095

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054009589 | IL | Yes |

## Other

- **Enumeration date:** 01/11/2007
- **Last updated:** 03/19/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2018420 | PK | — |