Organization
HALSTED PHARMACY INC
Active
Other names
Halsted Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RENNY KURUP PHARMD (DIR OF PHARMACY/SECRETARY)
(312) 624-9397
Entity
Organization
Contact information
Practice address
1460 N HALSTED ST STE 101, CHICAGO, IL 60642-2620
(312) 624-9397
(312) 624-8826
Mailing address
1460 N HALSTED ST STE 101, CHICAGO, IL 60642-2620
(312) 624-9397
(312) 624-8826
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054-017440
IL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125361
PK
—
Enumeration date
06/09/2010
Last updated
03/18/2016
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