Organization
CPTL HOME PHARMACY INC
Active
Other names
CPTL Home Pharmacy, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
EVANGELINE COOPER (PRESIDENT)
(312) 262-4520
Entity
Organization
Contact information
Practice address
1410 W FULTON ST, SUITE 201, CHICAGO, IL 60607-1110
(312) 262-4520
(312) 262-4531
Mailing address
1410 W FULTON ST, SUITE 201, CHICAGO, IL 60607-1110
(312) 262-4520
(312) 262-4531
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054017577
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1485209
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/16/2010
Last updated
12/28/2010
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