Provider Demographics
NPI:1174251953
Name:MCDERMOTT CENTER
Entity type:Organization
Organization Name:MCDERMOTT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR QA
Authorized Official - Prefix:
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:LEGEIA
Authorized Official - Last Name:BUFORD-FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-226-7984
Mailing Address - Street 1:120 N SANGAMON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:932 W. WASHINGTON ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2202
Practice Address - Country:US
Practice Address - Phone:312-226-7984
Practice Address - Fax:312-226-8048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCDERMOTT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-10
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy