Provider Demographics
NPI:1417056540
Name:PHARMORE DRUGS, LLC
Entity Type:Organization
Organization Name:PHARMORE DRUGS, LLC
Other - Org Name:PHARMORE DRUGS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF QUALITY AND COMPLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:K
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-679-7455
Mailing Address - Street 1:3412 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-6217
Mailing Address - Country:US
Mailing Address - Phone:847-679-7455
Mailing Address - Fax:847-679-7667
Practice Address - Street 1:3412 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-6217
Practice Address - Country:US
Practice Address - Phone:847-679-7455
Practice Address - Fax:847-679-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL054.0170373336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2023196OtherPK
2023196OtherPK