Provider Demographics
NPI:1871633578
Name:NORTHTOWN DRUGS
Entity Type:Organization
Organization Name:NORTHTOWN DRUGS
Other - Org Name:GOLDENSON DRUGS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-743-0887
Mailing Address - Street 1:2158 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2127
Mailing Address - Country:US
Mailing Address - Phone:773-743-0887
Mailing Address - Fax:773-743-0797
Practice Address - Street 1:2158 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2127
Practice Address - Country:US
Practice Address - Phone:773-743-0887
Practice Address - Fax:773-743-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL4564730001Medicare ID - Type Unspecified