Provider Demographics
NPI:1831310796
Name:UNIFORM & LOGO SHOPPE
Entity Type:Organization
Organization Name:UNIFORM & LOGO SHOPPE
Other - Org Name:DIV. OF WATER TOWER PLACE UNIFORMS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-926-3676
Mailing Address - Street 1:201 E HURON ST STE 1-200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3197
Mailing Address - Country:US
Mailing Address - Phone:312-926-3676
Mailing Address - Fax:312-926-5458
Practice Address - Street 1:201 E HURON ST STE 1-200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3197
Practice Address - Country:US
Practice Address - Phone:312-926-3676
Practice Address - Fax:312-926-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5669230001Medicare ID - Type Unspecified