Provider Demographics
NPI:1871673079
Name:HEALTH DELIVERY MANAGEMENT, LLC
Entity Type:Organization
Organization Name:HEALTH DELIVERY MANAGEMENT, LLC
Other - Org Name:PROFESSIONAL OFFICE BUILDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEATHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-942-2852
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 418
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-563-2093
Mailing Address - Fax:312-942-5503
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 418
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-563-2245
Practice Address - Fax:312-942-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
IL540116243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1465904OtherNABP CODE
IL1465904OtherNABP CODE
IL=========002Medicaid