Organization
PETERSONS PERSCRIPTION PHARMACY INC
Active
Other names
PETERSONS PRESCRIPTION PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM ELICH RPH (PRESIDENT)
(708) 868-5020
Entity
Organization
Contact information
Practice address
715 LAKE ST, OAK PARK, IL 60301-1467
(708) 848-5020
(708) 848-5022
Mailing address
715 LAKE ST, OAK PARK, IL 60301-1467
(708) 848-5020
(708) 848-5022
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054010011
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1459800
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
367728439001
—
IL
Enumeration date
08/10/2006
Last updated
08/31/2012
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