Provider Demographics
NPI:1073917225
Name:HM PHARMACY OF WINNETKA INCORPORATED
Entity Type:Organization
Organization Name:HM PHARMACY OF WINNETKA INCORPORATED
Other - Org Name:CONNEYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MRS.
Authorized Official - Prefix:
Authorized Official - First Name:SADAF
Authorized Official - Middle Name:
Authorized Official - Last Name:FECTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-446-0032
Mailing Address - Street 1:736 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2506
Mailing Address - Country:US
Mailing Address - Phone:847-446-0032
Mailing Address - Fax:847-446-1574
Practice Address - Street 1:736 ELM ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2506
Practice Address - Country:US
Practice Address - Phone:847-446-0032
Practice Address - Fax:847-446-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL054.0189163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149436OtherPK