Provider Demographics
NPI:1922485077
Name:GOOD HEALTH PHARMACY
Entity Type:Organization
Organization Name:GOOD HEALTH PHARMACY
Other - Org Name:GOOD HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLUYEMISI
Authorized Official - Middle Name:
Authorized Official - Last Name:IJOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-799-6098
Mailing Address - Street 1:3919 CALLANDER CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8306
Mailing Address - Country:US
Mailing Address - Phone:724-799-6098
Mailing Address - Fax:
Practice Address - Street 1:1999 SPRINGBROOK SQUARE DR UNIT 105
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5946
Practice Address - Country:US
Practice Address - Phone:630-210-8995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540187823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151608OtherPK