Organization
INGALLS PROF PHARMACY LLL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE A WITVOET RPH (PHARMACY MANAGER)
(708) 915-5166
Entity
Organization
Contact information
Practice address
19550 GOVERNORS HWY, FLOSSMOOR, IL 60422-2125
(708) 915-8453
(708) 915-8579
Mailing address
19550 GOVERNORS HWY, FLOSSMOOR, IL 60422-2125
(708) 915-8453
(708) 915-8579
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054-015549
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1478420
NABP NUMBER
—
Enumeration date
01/11/2007
Last updated
02/18/2016
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