Provider Demographics
NPI:1215025762
Name:PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
Entity Type:Organization
Organization Name:PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
Other - Org Name:MERCY PROFESIONAL BUILDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAGDALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LADAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-801-2557
Mailing Address - Street 1:1315 N HIGHLAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1459
Mailing Address - Country:US
Mailing Address - Phone:630-801-5733
Mailing Address - Fax:630-801-5896
Practice Address - Street 1:1315 N HIGHLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1459
Practice Address - Country:US
Practice Address - Phone:630-801-5733
Practice Address - Fax:630-801-5896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-0150543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1451424OtherNCPDP/NABP
IL=========034Medicaid
1451424OtherNCPDP/NABP