Provider Demographics
NPI:1467668426
Name:ILLINOIS PHARMACY MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ILLINOIS PHARMACY MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-303-0701
Mailing Address - Street 1:836 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:#343
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3667
Mailing Address - Country:US
Mailing Address - Phone:847-303-0701
Mailing Address - Fax:847-303-0709
Practice Address - Street 1:8725 W HIGGINS RD
Practice Address - Street 2:SUITE 485
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2716
Practice Address - Country:US
Practice Address - Phone:847-303-0701
Practice Address - Fax:847-303-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty