# INGALLS PROF PHARMACY LLL

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

## Provider details

- **NPI number:** 1992855092
- **Authorized official:** JULIE A WITVOET RPH (PHARMACY MANAGER)
- **Authorized official phone:** (708) 915-5166

## Contact information

- **Practice address:** 19550 GOVERNORS HWY, FLOSSMOOR, IL 60422-2125
- **Practice address phone:** (708) 915-8453
- **Practice address fax:** (708) 915-8579
- **Mailing address:** 19550 GOVERNORS HWY, FLOSSMOOR, IL 60422-2125
- **Mailing address phone:** (708) 915-8453
- **Mailing address fax:** (708) 915-8579

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054-015549 | IL | Yes |

## Other

- **Enumeration date:** 01/11/2007
- **Last updated:** 02/18/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1478420 | NABP NUMBER | — |