Organization
200 PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERMAN WHITE RPH (REG PHARMACIST AND VP)
(773) 374-4550
Entity
Organization
Contact information
Practice address
9133 S STONY ISLAND AVE, CHICAGO, IL 60617-3512
(773) 374-4550
(773) 374-4660
Mailing address
9133 S STONY ISLAND AVE, CHICAGO, IL 60617-3512
(773) 374-4550
(773) 374-4660
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
051032504
IL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1445178
OTHER ID NUMBER
—
Enumeration date
08/02/2005
Last updated
05/23/2011
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