Organization
THOREK MEMORIAL HOSPITAL
Active
Other names
Thorek Hospital Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JAY DAVID PHARMD (PHARMACIST IN CHARGE)
(773) 975-3235
Entity
Organization
Contact information
Practice address
850 W IRVING PARK RD, CHICAGO, IL 60613-3077
(773) 975-3235
(773) 975-3238
Mailing address
THOREK HOSPITAL OUTPATIENT PHARMACY, 850 W IRVING PARK RD, CHICAGO, IL 60613
(773) 975-3235
(773) 975-3238
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054017097
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1432981
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
3660000985401
—
IL
Enumeration date
05/25/2007
Last updated
11/07/2012
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