Organization
KOSIROG PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN R KOSIROG (OWNER)
(773) 486-3998
Entity
Organization
Contact information
Practice address
1000 N WESTERN AVE, CHICAGO, IL 60622-3685
(773) 486-3998
Mailing address
1000 N WESTERN AVE, CHICAGO, IL 60622-3685
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1671077
BCBS
IL
Enumeration date
03/14/2006
Last updated
04/06/2012
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