# GLEN ELLYN PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Glen Ellyn Pharmacy Health Care Shoppes
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932207750
- **Authorized official:** ROBERT E LISTECKI (PHARMACIST)
- **Authorized official phone:** (630) 469-5200

## Contact information

- **Practice address:** 486 ROOSEVELT ROAD, GLEN ELLYN, IL 60137-5611
- **Practice address phone:** (630) 469-5200
- **Mailing address:** 486 ROOSEVELT ROAD, GLEN ELLYN, IL 60137-5611
- **Mailing address phone:** (630) 469-5200

## Taxonomy

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

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1422891 | NATIONAL ASSOCIATON OF BO | — |