Provider Demographics
NPI:1760535892
Name:DEMPSTER POTTER PHARMACY
Entity Type:Organization
Organization Name:DEMPSTER POTTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:MARINOS
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAKRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-803-4585
Mailing Address - Street 1:2604 DEMPSTER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8412
Mailing Address - Country:US
Mailing Address - Phone:847-803-4585
Mailing Address - Fax:847-635-5671
Practice Address - Street 1:2604 DEMPSTER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8412
Practice Address - Country:US
Practice Address - Phone:847-803-4585
Practice Address - Fax:847-635-5671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid