Provider Demographics
NPI:1346541729
Name:CPTL HOME PHARMACY INC
Entity Type:Organization
Organization Name:CPTL HOME PHARMACY INC
Other - Org Name:CPTL HOME PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-262-4520
Mailing Address - Street 1:1410 W FULTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1110
Mailing Address - Country:US
Mailing Address - Phone:312-262-4520
Mailing Address - Fax:312-262-4531
Practice Address - Street 1:1410 W FULTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1110
Practice Address - Country:US
Practice Address - Phone:312-262-4520
Practice Address - Fax:312-262-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540175773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1485209OtherNCPDP PROVIDER IDENTIFICATION NUMBER