Organization
111TH PHARMA - FAMILY
Active
Other names
111th Pharma Family
Organization subpart
No
Provider details
NPI number
Authorized official
ADELE VANJACKSON (PIC)
(773) 785-5192
Entity
Organization
Contact information
Practice address
11101 S STATE ST, CHICAGO, IL 60628-4206
(773) 785-5192
(773) 821-6970
Mailing address
11101 S STATE ST, CHICAGO, IL 60628-4206
(773) 785-5192
(773) 821-6970
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054018137
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141774
PK
—
Enumeration date
10/25/2006
Last updated
08/27/2013
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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