Organization
INSTARX PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN FITZSIMMONS (CEO)
(708) 478-0119
Entity
Organization
Contact information
Practice address
18927 HICKORY CREEK DR STE 135, MOKENA, IL 60448
(708) 478-0119
(708) 478-0147
Mailing address
18927 HICKORY CREEK DR STE 135, MOKENA, IL 60448-8649
(708) 478-0119
(708) 478-0147
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054.020874
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054.020874
ILLINOIS BOARD OF PHARMACY LICENSED PHARMACY
IL
01
—
320.012772
ILLINOIS BOARD OF PHARMACY LICENSED CONTROLLED SUBSTANCE LICENSE
IL
Enumeration date
08/12/2018
Last updated
08/29/2018
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