Organization
COOK COUNTY
Active
Parent organization
COOK COUNTY
Other names
Cook County Health at Blue Island Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
COOK COUNTY
Authorized official
GERVAISE HUNTER-MORRIS (PHARMACY SUPERVISOR)
(708) 293-8411
Entity
Organization
Contact information
Practice address
12757 WESTERN AVE, BLUE ISLAND, IL 60406-2155
(708) 293-8400
(708) 293-8408
Mailing address
12757 WESTERN AVE, BLUE ISLAND, IL 60406-2155
(708) 293-8400
(708) 293-8408
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
054017270
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023252
PK
—
05
—
355005541070
—
IL
Enumeration date
07/17/2006
Last updated
08/23/2022
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