Organization
900 PHARMACY LLC
Active
Other names
900 PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
VALENCIA WILSON (OFFICER)
(773) 907-9007
Entity
Organization
Contact information
Practice address
4527 N SHERIDAN RD, CHICAGO, IL 60640-5608
(773) 907-9009
(773) 907-9001
Mailing address
4527 N SHERIDAN RD, CHICAGO, IL 60640-5608
(773) 907-9009
(773) 907-9001
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054017733
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1486011
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/13/2011
Last updated
10/14/2011
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