Provider Demographics
NPI:1114645470
Name:ADVOCATE NORTH SIDE HEALTH NETWORK
Entity Type:Organization
Organization Name:ADVOCATE NORTH SIDE HEALTH NETWORK
Other - Org Name:ADVOCATE PHARMACY #1510
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP FINANCIAL OPS
Authorized Official - Prefix:
Authorized Official - First Name:NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-299-1610
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53082-0208
Mailing Address - Country:US
Mailing Address - Phone:920-803-3266
Mailing Address - Fax:920-459-2634
Practice Address - Street 1:836 W WELLINGTON AVE STE 1801
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5147
Practice Address - Country:US
Practice Address - Phone:872-843-3160
Practice Address - Fax:872-843-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy