Provider Demographics
NPI:1942445077
Name:PERSONAL CARE PHARMACY
Entity Type:Organization
Organization Name:PERSONAL CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-983-6170
Mailing Address - Street 1:600 HOLIDAY PLAZA DR
Mailing Address - Street 2:SUITE160 B
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2241
Mailing Address - Country:US
Mailing Address - Phone:708-983-6170
Mailing Address - Fax:
Practice Address - Street 1:600 HOLIDAY PLAZA DR
Practice Address - Street 2:SUITE160 B
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2241
Practice Address - Country:US
Practice Address - Phone:708-983-6170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy