Organization
SOUTHGATE PHARMACY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARD J SKONIECKE JR. (MANAGER)
(708) 798-2100
Entity
Organization
Contact information
Practice address
18659 DIXIE HWY, HOMEWOOD, IL 60430-3728
(708) 798-2100
(708) 798-0686
Mailing address
18659 DIXIE HWY, HOMEWOOD, IL 60430-3728
(708) 798-2100
(708) 798-0686
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1401594
NABP
—
Enumeration date
10/25/2005
Last updated
08/22/2020
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