Organization
ST JUDE PHARMACY, INC.
Active
Other names
ST. JUDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMED J ALAHMED RPH. (PHARMACIST IN CHARGE)
(815) 900-9000
Entity
Organization
Contact information
Practice address
301 MADISON ST STE 114, JOLIET, IL 60435-6549
(815) 900-9000
(815) 900-5500
Mailing address
301 MADISON ST STE 114, JOLIET, IL 60435-6549
(815) 900-9000
(815) 900-5500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054021109
ILLINOIS DEPARTMENT IF FINANCIAL AND PROFESSIONAL REGULATION PHARMACY LICENSE
IL
01
—
320012950
IDFPR ILLINOIC CONTROLLED PHARMACY LICENSE
IL
Enumeration date
02/06/2019
Last updated
04/12/2019
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