Fullerton Kedzie Professional Pharmacy

LBN: Fullerton Kedzie Professional Pharmacy
Fullerton Kedzie Professional Pharmacy is an health care organization with primary practice located at 3153 W Fullerton Ave , Chicago IL 60647-2809. The organization recently has only one registered license in Suppliers / Community/Retail Pharmacy, which is considered as the primary health care specialty. Fullerton Kedzie Professional Pharmacy can be contacted via phone (773) 278-6604, or through Boggetto, Ettore via phone (773) 278-6604.

Contact Information

Primary practice address
3153 W Fullerton Ave Chicago IL 60647-2809
Phone: (773) 278-6604
Fax: (773) 395-4633
Website:
Map and Directions
Authorized official contact:
Name: Boggetto, Ettore RPH
Phone: (773) 278-6604

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X 054-007134 Illinois

Profile Details

NPI number 1083005078
LBN Legal business name Fullerton Kedzie Professional Pharmacy
DBA Doing business as
Authorized official Boggetto, Ettore RPH
Entity Organization
Organization subpart 1 No
Enumeration date Feb 11th, 2015
Last updated Feb 11th, 2015 - about 11 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 1083005078 NPPES
Illinois MEDICAID 355363043002

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