Organization
SUPERIOR PHARMACY
Active
Other names
Superior Pharmacy Inc
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN JACKSON (OWNER)
(773) 619-4102
Entity
Organization
Contact information
Practice address
356 W SUPERIOR ST, RM 301-302, CHICAGO, IL 60654-3416
(312) 988-7300
Mailing address
356 W SUPERIOR ST, RM 301-302, CHICAGO, IL 60654-3416
Taxonomy
Speciality
Code
Description
License number
State
3336M0002X
Mail Order Pharmacy
Primary
054016533
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1482912
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/10/2009
Last updated
02/10/2009
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