Provider Demographics
NPI:1528002375
Name:GOOD SHEPHERD D O B PHARMACY
Entity Type:Organization
Organization Name:GOOD SHEPHERD D O B PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUNHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-381-1230
Mailing Address - Street 1:450 W HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 W HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1901
Practice Address - Country:US
Practice Address - Phone:847-381-1230
Practice Address - Fax:847-381-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL54010043333600000X
3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1444835OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1444835OtherOTHER ID NUMBER-COMMERCIAL NUMBER