Organization
MEDSHOP INC
Active
Other names
MEDICINE STOP OF RIVER FOREST
Organization subpart
No
Provider details
NPI number
Authorized official
TOM KUKULSKI B.S. (PRESIDENT)
(708) 771-6363
Entity
Organization
Contact information
Practice address
7756 MADISON ST, RIVER FOREST, IL 60305-2058
(708) 771-6363
(708) 771-6368
Mailing address
7756 MADISON ST, RIVER FOREST, IL 60305-2058
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054008943
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1453137
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/10/2006
Last updated
03/26/2009
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