Organization
FORUM EXTENDED CARE SVC INC II
Active
Other names
FORUM EXTENDED CARE SVC INC II
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN KRAMER (PRESIDENT)
(847) 673-8727
Entity
Organization
Contact information
Practice address
4201 W VICTORIA ST, CHICAGO, IL 60646-6700
(847) 673-8727
(847) 673-6215
Mailing address
4201 W VICTORIA ST, CHICAGO, IL 60646-6700
(847) 673-8727
(847) 673-6215
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
64001297A
IN
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336I0012X
Institutional Pharmacy
1204-43
WI
3336L0003X
Long Term Care Pharmacy
Primary
054017240
IL
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201063520 A
—
IN
01
—
2022130
PK
—
05
—
33245400
—
WI
05
—
36855933001
—
IL
Enumeration date
05/13/2006
Last updated
04/22/2021
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