Provider Demographics
NPI:1093971624
Name:TRUE HEALTH MEDICAL CENTER S C
Entity Type:Organization
Organization Name:TRUE HEALTH MEDICAL CENTER S C
Other - Org Name:PURE COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:630-995-4300
Mailing Address - Street 1:603 E DIEHL RD
Mailing Address - Street 2:STE 131
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1452
Mailing Address - Country:US
Mailing Address - Phone:630-995-4300
Mailing Address - Fax:630-995-4301
Practice Address - Street 1:603 E DIEHL RD
Practice Address - Street 2:STE 131
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1452
Practice Address - Country:US
Practice Address - Phone:630-995-4300
Practice Address - Fax:630-995-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
IL05401616363336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116405OtherPK