Provider Demographics
NPI:1144593641
Name:MARK DRUGS NORTHSHORE, INC
Entity Type:Organization
Organization Name:MARK DRUGS NORTHSHORE, INC
Other - Org Name:NORTHSHORE INTEGRATIVE MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BATOGOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:847-419-9898
Mailing Address - Street 1:1020 MILWAUKEE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3558
Mailing Address - Country:US
Mailing Address - Phone:847-419-9898
Mailing Address - Fax:847-419-9899
Practice Address - Street 1:1020 MILWAUKEE AVE STE 140
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3558
Practice Address - Country:US
Practice Address - Phone:847-419-9898
Practice Address - Fax:847-419-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291609183500000X
IL036.079383208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILFM0802593OtherDEA #