1043486269 NPI number — MARK DRUGS NORTHSHORE INC

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 1043486269 NPI number — MARK DRUGS NORTHSHORE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK DRUGS NORTHSHORE INC
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:
MARK DRUGS NORTHSHORE INC
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:
1043486269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 MILWAUKEE AVE
Provider Second Line Business Mailing Address:
STE 140
Provider Business Mailing Address City Name:
DEERFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-3513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-419-9898
Provider Business Mailing Address Fax Number:
847-419-9899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
STE 140
Provider Business Practice Location Address City Name:
DEERFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-419-9898
Provider Business Practice Location Address Fax Number:
847-419-9899
Provider Enumeration Date:
05/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BATOGOWSKI
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-699-2164

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  054016368 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2023676 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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