Organization
MEDCENTRIX INC.
Active
Other names
Ingalls Pro Pharm ll
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD J. RUTKOWSKI (PHARMACY MANAGER)
(708) 915-7550
Entity
Organization
Contact information
Practice address
6701 159TH ST, TINLEY PARK, IL 60477-1758
(708) 915-7550
(708) 915-7507
Mailing address
6701 159TH ST, TINLEY PARK, IL 60477-1758
(708) 915-7550
(708) 915-7507
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054015155
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363374008002
—
IL
Enumeration date
04/25/2008
Last updated
04/25/2008
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