Provider Demographics
NPI:1932225711
Name:WEBSTER DRUG INC
Entity Type:Organization
Organization Name:WEBSTER DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ROGOWIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:312-567-1490
Mailing Address - Street 1:610 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3023
Mailing Address - Country:US
Mailing Address - Phone:312-567-1490
Mailing Address - Fax:312-567-0651
Practice Address - Street 1:610 W 31ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3023
Practice Address - Country:US
Practice Address - Phone:312-567-1490
Practice Address - Fax:312-567-0651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1464483OtherPROVIDER NO 3RD PARTY
IL361389858002Medicaid