Provider Demographics
NPI:1093818148
Name:ALTGELD GARDEN DRUG CO.
Entity Type:Organization
Organization Name:ALTGELD GARDEN DRUG CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERSKINE
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:CARTWRIGHT
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-264-0787
Mailing Address - Street 1:974 E 133RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60827-1428
Mailing Address - Country:US
Mailing Address - Phone:773-264-0787
Mailing Address - Fax:773-264-1191
Practice Address - Street 1:974 E 133RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60827-1428
Practice Address - Country:US
Practice Address - Phone:773-264-0787
Practice Address - Fax:773-264-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid