Organization
SCHOLL PHARMACY INC
Active
Other names
FAGEN PHARMACY 17
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE COFFER (3RD PARTY COORD)
(219) 987-6468
Entity
Organization
Contact information
Practice address
4840 W COURT ST, MONEE, IL 60449-8988
(708) 534-3343
(708) 534-1638
Mailing address
FAGEN PHARMACY, PO BOX 9830, SALT LAKE CITY, UT 84109-9913
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
54014974
IL
3336C0003X
Community/Retail Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1475905
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/21/2006
Last updated
05/21/2008
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