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PROVENA PHARMACY ELGIN

Medical Equipment Supplier Yellow Pages

Elgin, Illinois

Provider NPI: 1811902455

Organization Information:
Organization Name:  PROVENA PHARMACY ELGIN


Practice Location:
750 FLETCHER DR STE 103 ELGIN, IL 60123 US
Tel: 847-931-5535  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X3336C0002XSuppliers
Pharmacy
Clinic Pharmacy
IL54013758
X3336C0003XSuppliers
Pharmacy

Other Provider Identifiers:

IssuerNumberStateType
OTHER ID NUMBER-COMMERCIAL NUMBER146080301
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




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