Provider Demographics
NPI:1023389434
Name:PHARMACY HEALTHCARE SOLUTIONS LTD
Entity Type:Organization
Organization Name:PHARMACY HEALTHCARE SOLUTIONS LTD
Other - Org Name:ALLSTATE GOOD LIFE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:901-409-7091
Mailing Address - Street 1:2775 SANDERS RD STE C1
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6110
Mailing Address - Country:US
Mailing Address - Phone:847-402-9400
Mailing Address - Fax:847-402-9420
Practice Address - Street 1:2775 SANDERS RD STE C1
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6110
Practice Address - Country:US
Practice Address - Phone:847-402-9400
Practice Address - Fax:847-402-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540178293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133592OtherPK