Organization
MEDCENTRIX INC
Active
Other names
INGALLS PROOF PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD RUTKOWSKI RPH (PHARMACY MANAGER)
(815) 703-8434
Entity
Organization
Contact information
Practice address
31 W 155TH ST, HARVEY, IL 60426-3556
(708) 589-2019
Mailing address
31 W 155TH ST, HARVEY, IL 60426-3556
(708) 589-2019
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054016131
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1480639
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/13/2007
Last updated
02/04/2010
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