Organization
GLEN ELLYN PHARMACY INC
Active
Other names
Glen Ellyn Pharmacy Health Care Shoppes
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT E LISTECKI (PHARMACIST)
(630) 469-5200
Entity
Organization
Contact information
Practice address
486 ROOSEVELT ROAD, GLEN ELLYN, IL 60137-5611
(630) 469-5200
Mailing address
486 ROOSEVELT ROAD, GLEN ELLYN, IL 60137-5611
(630) 469-5200
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1422891
NATIONAL ASSOCIATON OF BO
—
Enumeration date
09/20/2006
Last updated
03/07/2023
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