Provider Demographics
NPI:1780066456
Name:TINLEY PARK PHARMACY, INC
Entity type:Organization
Organization Name:TINLEY PARK PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDADIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:312-804-9469
Mailing Address - Street 1:18210 S. LAGRANGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7722
Mailing Address - Country:US
Mailing Address - Phone:708-995-7290
Mailing Address - Fax:708-995-7371
Practice Address - Street 1:18210 S. LAGRANGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7722
Practice Address - Country:US
Practice Address - Phone:708-995-7290
Practice Address - Fax:708-995-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.019388332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies