Provider Demographics
NPI:1598398455
Name:WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC
Entity Type:Organization
Organization Name:WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC
Other - Org Name:WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS - CANCER CENTER PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-791-0975
Mailing Address - Street 1:1418 CROSS STREET
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269
Mailing Address - Country:US
Mailing Address - Phone:618-607-1419
Mailing Address - Fax:618-622-9719
Practice Address - Street 1:1418 CROSS STREET
Practice Address - Street 2:SUITE 180
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-607-1419
Practice Address - Fax:618-622-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy