Organization
INGALLS PROF PHARMACY LL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE A WITVOET RPH (PHARMACY MANAGER)
(708) 915-5166
Entity
Organization
Contact information
Practice address
6701 159TH ST, TINLEY PARK, IL 60477-1758
(708) 915-7550
(708) 915-7507
Mailing address
6701 159TH ST, TINLEY PARK, IL 60477-1758
(708) 915-7550
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054-015155
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1476933
NABP NUMBER
—
Enumeration date
01/11/2007
Last updated
02/18/2016
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