Organization
FULLERTON KEDZIE PROFESSIONAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ETTORE BOGGETTO RPH (PHARMACIST-IN-CHARGE)
(773) 278-6604
Entity
Organization
Contact information
Practice address
3153 W FULLERTON AVE, CHICAGO, IL 60647-2809
(773) 278-6604
(773) 395-4633
Mailing address
3153 W FULLERTON AVE, CHICAGO, IL 60647-2809
(773) 278-6604
(773) 395-4633
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054-007134
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
355363043002
—
IL
Enumeration date
02/11/2015
Last updated
02/11/2015
Update your record
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