Provider Demographics
NPI:1043219652
Name:HARBOR PHARMACY INC
Entity Type:Organization
Organization Name:HARBOR PHARMACY INC
Other - Org Name:HARBOR HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWER/RPH
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:847-872-5427
Mailing Address - Street 1:1707 7TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WINTHROP HARBOR
Mailing Address - State:IL
Mailing Address - Zip Code:60096-1656
Mailing Address - Country:US
Mailing Address - Phone:847-872-5427
Mailing Address - Fax:847-872-9645
Practice Address - Street 1:1707 7TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WINTHROP HARBOR
Practice Address - State:IL
Practice Address - Zip Code:60096-1656
Practice Address - Country:US
Practice Address - Phone:847-872-5427
Practice Address - Fax:847-872-9645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBOR PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-15
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203-000579332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1428603OtherNCPDP
IL04932338OtherBCBS ID NUMBER
IL1428603OtherNCPDP
IL=========001Medicaid