Provider Demographics
NPI:1952789398
Name:AMERICAN CLINICAL SUPPLIES
Entity Type:Organization
Organization Name:AMERICAN CLINICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:YOUNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-279-5350
Mailing Address - Street 1:3101 W DEVON STO
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659
Mailing Address - Country:US
Mailing Address - Phone:773-279-5350
Mailing Address - Fax:847-754-4991
Practice Address - Street 1:3101 W DEVON AVE # STO
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1407
Practice Address - Country:US
Practice Address - Phone:773-279-5350
Practice Address - Fax:847-754-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy