Provider Demographics
NPI:1255485090
Name:LUDEMAN HUB PHARMACY
Entity Type:Organization
Organization Name:LUDEMAN HUB PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SERVICES MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:HITER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:708-283-3194
Mailing Address - Street 1:114 N ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1200
Mailing Address - Country:US
Mailing Address - Phone:708-283-3262
Mailing Address - Fax:708-283-3188
Practice Address - Street 1:114 N ORCHARD DR
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1200
Practice Address - Country:US
Practice Address - Phone:708-283-3262
Practice Address - Fax:708-283-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540173113336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty