Provider Demographics
NPI:1225412786
Name:PRAXIS SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:PRAXIS SPECIALTY PHARMACY, LLC
Other - Org Name:PRAXISRX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:888-510-3383
Mailing Address - Street 1:1144 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-6705
Mailing Address - Country:US
Mailing Address - Phone:888-903-7453
Mailing Address - Fax:888-958-2831
Practice Address - Street 1:455 N HARLEM AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-2020
Practice Address - Country:US
Practice Address - Phone:888-510-3383
Practice Address - Fax:708-330-4467
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAXIS SPECIALTY PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540194393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy