Provider Demographics
NPI:1043375793
Name:CENTRAL CLEARING DRUGS INC
Entity Type:Organization
Organization Name:CENTRAL CLEARING DRUGS INC
Other - Org Name:CENTRAL DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHLENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-586-5555
Mailing Address - Street 1:6400 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-5004
Mailing Address - Country:US
Mailing Address - Phone:773-586-5555
Mailing Address - Fax:773-586-5566
Practice Address - Street 1:6400 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-5004
Practice Address - Country:US
Practice Address - Phone:773-586-5555
Practice Address - Fax:773-586-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540051303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL4631850001Medicare NSC