Organization
UNION HEALTH SERVICE INC
Active
Other names
Union Health Service, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON STULL BS PHARMACY (PHARMACY MANAGER)
(312) 423-4260
Entity
Organization
Contact information
Practice address
1634 W POLK ST, CHICAGO, IL 60612-4352
(312) 423-4260
(312) 423-4392
Mailing address
1634 W POLK ST, CHICAGO, IL 60612-4352
(312) 423-4260
(312) 423-4392
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
054017371
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2022577
PK
—
Enumeration date
08/31/2006
Last updated
07/19/2018
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