Organization
LAKE COUNTY INTERNAL MEDICINE ASSOC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACKENZIE HAHN (NCPDP COORDINATOR)
(888) 590-0808
Entity
Organization
Contact information
Practice address
15 TOWER CT., STE 190, GURNEE, IL 60031
(888) 590-0808
(866) 740-4689
Mailing address
200 RITTENHOUSE CIRCLE, EAST BUILDING STE 5, BRISTOL, PA 19007
(888) 590-0808
(866) 740-4689
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
036093940
IL
Other
Enumeration date
04/16/2018
Last updated
04/16/2018
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