Provider Demographics
NPI:1033389374
Name:MEDIDERM INC.
Entity Type:Organization
Organization Name:MEDIDERM INC.
Other - Org Name:MEDIDERMRX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:LINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-966-0670
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-7535
Mailing Address - Country:US
Mailing Address - Phone:847-966-3192
Mailing Address - Fax:847-966-5046
Practice Address - Street 1:650 W LAKE COOK RD STE 150
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2082
Practice Address - Country:US
Practice Address - Phone:800-966-0670
Practice Address - Fax:800-965-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540131363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy