1336289016 NPI number — UNIVERSITY OF ILLINOIS SCB PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336289016 NPI number — UNIVERSITY OF ILLINOIS SCB PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF ILLINOIS SCB PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNIVERSITY OF ILLINOIS TAYLOR STREET EEI PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336289016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
833 S WOOD ST
Provider Second Line Business Mailing Address:
ROOM 161 MC 874
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-355-2035
Provider Business Mailing Address Fax Number:
312-276-4800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 S WOOD ST
Provider Second Line Business Practice Location Address:
ROOM 1025 MC 874
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-6540
Provider Business Practice Location Address Fax Number:
312-276-4800
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
KRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY TECHNICIAN SPECIALIST
Authorized Official Telephone Number:
312-355-2035

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  054.017117 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 054-017117 . This is a "STATE PHARMACY LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 032-005937 . This is a "STATE CONTROLLED SUBSTANC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1464205 . This is a "NCPDP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com