Provider Demographics
NPI:1487752705
Name:PALOS HILLS PHARMACY, INC.
Entity type:Organization
Organization Name:PALOS HILLS PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:CIPRIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-448-4141
Mailing Address - Street 1:7600 W COLLEGE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1035
Mailing Address - Country:US
Mailing Address - Phone:708-448-4141
Mailing Address - Fax:708-448-4343
Practice Address - Street 1:7600 W COLLEGE DR STE 1
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1035
Practice Address - Country:US
Practice Address - Phone:708-448-4141
Practice Address - Fax:708-448-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054004339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1406897OtherNABP NO
IL1406897OtherNABP NO
IL=========001Medicaid