Fagen Pharmacy 15

NPI 1861413189 - Pharmacy - 333600000X

NPI Details
NPI 1861413189
Enumeration Date 07/21/2006
Last Updated 04/20/2008
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name LARRY LARRY
Position 3RD PARTY COORD
Phone (708) 479-9333
Fax (708) 479-5633
Practice Location
11112 FRONT ST
MOKENA IL, 60448-1562, US
Phone (708) 479-9333
Fax (708) 479-5633
Business Location
FAGEN PHARMACY
PO BOX 9830
SALT LAKE CITY UT, 84109-9913, US
Phone
Fax
Toxanomy
Taxonomy Code 333600000X
License State Illinois
License Number 54014975
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According to our database, Fagen Pharmacy 15 NPI is 1861413189, taxonomy code is 333600000X and license number is 54014975, license state is located at Illinois. Fagen Pharmacy 15 physically located at 11112 Front St, Mokena IL, 60448-1562. NPI Number 1033115704 has the healthcare provider type.

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1861413189 NPI number is provided on an as is basis without warranty of any kind. 1861413189 is maintained by the National Plan & Provider Enumeration System. The contents of Fagen Pharmacy 15 are for informational purposes only.