111TH PHARMA-FAMILY – NPI #1659616175
Clinic/Center

111TH PHARMA-FAMILY is an AHC clinic located in CHICAGO, IL. NPPES has assigned the NPI number 1659616175 to 111TH PHARMA-FAMILY on December 10, 2012. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QH0100X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Health Service

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for 111TH PHARMA-FAMILY below.

NPI Profile for
111TH PHARMA-FAMILY

NPI Number
1659616175
Enumeration Date

(more than 13 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
111TH PHARMA-FAMILY
Primary location
11101 S STATE ST
CHICAGO, IL 60628-4206
Phone: (708) 503-9845 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
ADELE VANJACKSON
OWNER/PHARMACIST
Phone: (708) 503-9845
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QH0100X
- Clinic/Center / Health Service (Primary)		 IL 051035317

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.