Organization
INGALLS PROFESSIONAL PHARMACY 4
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RON RUTKOWSKI (PHARMACY MANAGER)
(708) 333-5388
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
183500000X
Pharmacist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1480639
NCPDP NUMBER
—
Enumeration date
03/14/2007
Last updated
08/22/2020
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