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111TH PHARMA - FAMILY NPI 1255415386


NPI Information

NPI: 1255415386
Provider Name: 111TH PHARMA - FAMILY

Doing Business As: 111TH PHARMA FAMILY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
11101 S STATE ST
CHICAGO, IL
ZIP 60628
Phone: (773) 785-5192
Get Directions

111TH PHARMA - FAMILY is a community/retail pharmacy pharmacy in Chicago, IL. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. 111TH PHARMA - FAMILY NPI is 1255415386. The provider is registered as an organization entity type.
The provider Is Doing Business As 111th Pharma Family.

The provider's business location address is:

11101 S STATE ST
CHICAGO, IL
ZIP 60628-206
Phone: (773) 785-5192
Fax: (773) 821-6970

The provider's authorized official is Adele Vanjackson .
The authorized official title is Pic and has the following contact phone number (773) 785-5192.

The enumeration date for this NPI number is 10/25/2006 and was last updated on 8/27/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13336C0003XPharmacyCommunity/Retail Pharmacy054018137ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12141774OTHERPK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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