Organization
CHURCH ST PHARM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK JACOBS RPH (CHIEF PHARMACIST)
(847) 674-5882
Entity
Organization
Contact information
Practice address
9669 KENTON AVE, SKOKIE, IL 60076-1266
(847) 674-5882
(847) 674-9824
Mailing address
9669 KENTON AVE, SKOKIE, IL 60076-1266
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
54009433
IL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1456284
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
362405956001
—
IL
Enumeration date
10/07/2006
Last updated
10/28/2009
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