BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Medical Equipment Supplier Yellow Pages
Chicago, Illinois
Provider NPI: 1447390125
Organization Information:Organization Name: BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Practice Location:
722 W MAXWELL ST ROOM 205 MC 184 CHICAGO, IL 60607 US
Tel: 312-355-2345 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
722 W MAXWELL ST ROOM 205 MC 184 CHICAGO, IL 60607 US
Tel: 312-355-2345 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 3336C0002X | Suppliers Pharmacy Clinic Pharmacy | IL | 054.017253 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
STATE CONTROLLED SUBSTANC | 032-008745 | IL | 01 |
NCPDP NUMBER | 1479876 | IL | 01 |
STATE PHARMACY LICENSE | 054-017253 | IL | 01 |
DEA NUMBER | BU9820071 | IL | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin