Organization
CONNEYS ELM STREET PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK JACOBS (PHARMACIST AND OWNER)
(847) 446-0032
Entity
Organization
Contact information
Practice address
736 ELM ST, WINNETKA, IL 60093-2506
(847) 446-3335
(847) 446-1574
Mailing address
736 ELM ST, WINNETKA, IL 60093-2506
(847) 446-0032
(847) 446-1574
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054013973
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1428564
OTHER ID NUMBER
—
Enumeration date
07/30/2006
Last updated
12/06/2011
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