Organization
ILLINOIS DEPARTMENT OF HUMAN
Active
Other names
Shapiro Developmental Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RONDA ANN SUMNER RPH (PHARMACY MANAGER)
(815) 939-8272
Entity
Organization
Contact information
Practice address
100 E JEFFERY ST, KANKAKEE, IL 60901-5018
(815) 939-8272
(815) 939-8274
Mailing address
100 E JEFFERY ST, KANKAKEE, IL 60901-5018
(815) 939-8272
(815) 939-8274
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
054.020222
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023336
PK
—
Enumeration date
01/22/2007
Last updated
07/13/2022
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