Organization
LOCKPORT PHARMACY INC
Active
Other names
CORWIN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER BEICH (PRESIDENT)
(815) 838-3733
Entity
Organization
Contact information
Practice address
954 E 9TH ST, LOCKPORT, IL 60441-3236
(815) 838-3733
(815) 838-1059
Mailing address
954 E 9TH ST, LOCKPORT, IL 60441-3236
(815) 838-3733
(815) 838-1059
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054008019
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447805
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/18/2005
Last updated
01/04/2013
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