1518114750 NPI number — ADVENTIST GLENOAKS HOSPITAL OUTPATIENT PHARMACY

Table of content: (NPI 1518114750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518114750 NPI number — ADVENTIST GLENOAKS HOSPITAL OUTPATIENT PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENTIST GLENOAKS HOSPITAL OUTPATIENT 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:
UCHICAGO MEDICINE ADVENTHEALTH PHARMACY GLENOAKS
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:
1518114750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 WINTHROP AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60139-1405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-545-7310
Provider Business Mailing Address Fax Number:
630-545-7315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 WINTHROP AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60139-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-545-7310
Provider Business Practice Location Address Fax Number:
630-545-7315
Provider Enumeration Date:
08/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NEUMAN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
224-273-0516

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 054017422 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2117107 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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