Church St Pharm Inc

LBN: Church St Pharm Inc
Church St Pharm Inc is an health care organization with primary practice located at 9669 Kenton Ave , Skokie IL 60076-1266. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Pharmacy is the primary health care specialty. Church St Pharm Inc can be contacted via phone (847) 674-5882, or through Jacobs, Mark via phone (847) 674-5882.

Contact Information

Primary practice address
9669 Kenton Ave Skokie IL 60076-1266
Phone: (847) 674-5882
Fax: (847) 674-9824
Website:
Map and Directions
Authorized official contact:
Name: Jacobs, Mark RPH
Phone: (847) 674-5882

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X 54009433 Illinois
Suppliers / Community/Retail Pharmacy 3336C0003X

Profile Details

NPI number 1891882080
LBN Legal business name Church St Pharm Inc
DBA Doing business as
Authorized official Jacobs, Mark RPH
Entity Organization
Organization subpart 1 No
Enumeration date Oct 7th, 2006
Last updated Oct 28th, 2009 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891882080 NPPES
Illinois MEDICAID 362405956001
Illinois Other 1456284

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