Organization
PETERSON PHARMACY INC
Active
Other names
PETERSON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ALTAMASH KHAN (MANAGER)
(224) 619-9786
Entity
Organization
Contact information
Practice address
2517 W PETERSON AVE, CHICAGO, IL 60659-4108
(773) 275-6300
(773) 275-6400
Mailing address
2517 W PETERSON AVE, CHICAGO, IL 60659-4108
(773) 275-6300
(773) 275-6400
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054.019535
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154868
PK
—
Enumeration date
10/22/2015
Last updated
01/21/2016
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