Provider Demographics
NPI:1033155940
Name:DUNDEE PHARMACY INC
Entity Type:Organization
Organization Name:DUNDEE PHARMACY INC
Other - Org Name:DUNDEE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:847-480-1000
Mailing Address - Street 1:2750 DUNDEE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2600
Mailing Address - Country:US
Mailing Address - Phone:847-480-1000
Mailing Address - Fax:847-480-1988
Practice Address - Street 1:2750 DUNDEE RD
Practice Address - Street 2:#9
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2600
Practice Address - Country:US
Practice Address - Phone:847-480-1000
Practice Address - Fax:847-480-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X, 3336S0011X
IL203.001561332B00000X
IL0540151353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1441740OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1441740OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0146530001Medicare NSC