Organization
PRO PHARMACY INC
Active
Other names
PRO PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
AUGUSTUS LEWELLEN (OWNER)
(312) 824-8012
Entity
Organization
Contact information
Practice address
45-47 E FULLERTON AVE, ADDISON, IL 60101-4601
(773) 928-6850
(773) 928-5662
Mailing address
45-47 E FULLERTON AVE, ADDISON, IL 60101-4601
(773) 928-6850
(773) 928-5662
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054020261
IL
3336L0003X
Long Term Care Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021422
PK
—
Enumeration date
08/10/2006
Last updated
01/26/2017
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