Organization
SIMSUM INC
Active
Other names
MEDICAL ARTS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH SMULKAITIS (PHCY MGR)
(815) 758-3100
Entity
Organization
Contact information
Practice address
625 BETHANY RD STE 2, DEKALB, IL 60115-4908
(815) 758-3100
(815) 758-3105
Mailing address
625 BETHANY RD STE 2, DEKALB, IL 60115-4908
(815) 758-3100
(815) 758-3105
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054034923
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1475842
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/24/2006
Last updated
06/01/2010
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