Organization
MEDCENTRIX INC
Active
Other names
INGALLS PROFESSIONAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE WITVOET (PHARMACY MANAGER)
(708) 915-4306
Entity
Organization
Contact information
Practice address
71 W 156TH ST, SUITE 104, HARVEY, IL 60426-4260
(708) 915-4306
(708) 915-2095
Mailing address
71 W 156TH ST, SUITE 104, HARVEY, IL 60426-4260
(708) 915-4306
(708) 915-2095
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054009589
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018420
PK
—
Enumeration date
01/11/2007
Last updated
03/19/2014
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