NPIMap

Organization Active NPI

Medcentrix Inc.

Doing business as Ingalls Pro Pharm ll

  • Community/Retail Pharmacy
  • Tinley Park, IL
National Provider Identifier
1487829990
Registry record updated Apr 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054015155 Issued in IL
Legal business name
MEDCENTRIX INC.
Doing business as
Ingalls Pro Pharm ll
Practice address
6701 159TH St
Tinley Park, IL 60477-1758
Phone
(708) 915-7550
Fax
(708) 915-7507
NPI assigned
Apr 25, 2008
Last updated
Apr 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ronald J. Rutkowski
Title
Pharmacy Manager
Phone
(708) 915-7550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054015155 IL Primary

Addresses

Primary practice location

6701 159TH St
Tinley Park, IL 60477-1758

Mailing address

6701 159TH St
Tinley Park, IL 60477-1758
Phone (708) 915-7550

Other identifiers 1

IdentifierTypeStateIssuer
363374008002MedicaidIL

Other names 1

  • Ingalls Pro Pharm ll Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ingalls Prof Pharmacy LLL10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209081600000",
    "number": "1487829990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 159TH ST",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771758",
            "telephone_number": "708-915-7550",
            "fax_number": "708-915-7507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 159TH ST",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771758",
            "telephone_number": "708-915-7550",
            "fax_number": "708-915-7507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDCENTRIX INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-25",
        "last_updated": "2008-04-25",
        "status": "A",
        "authorized_official_last_name": "RUTKOWSKI",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "708-915-7550",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054015155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "363374008002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ingalls Pro Pharm ll",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tinley Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.