29 E Madison Corp
Organization Active NPI Community/Retail Pharmacy · Chicago, IL
NPI 1497837009 · NPPES record last updated Mar 9, 2010
Key facts
- NPI
- 1497837009
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 054013583 (IL)
- Legal business name
- 29 E MADISON CORP
- Practice address
- 25 E Washington St Lowr 53
Lower Level Pedway
Chicago, IL 60602-1736 - Phone
- (312) 263-7194
- Fax
- (312) 263-7636
- NPI assigned
- Oct 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Mark Edelheit, RPH
- Title
- Owner
- Phone
- (312) 263-7194
National Provider Directory
Locations
25 E Washington St
Lowr 53
Chicago, IL 60602
Phone (312) 263-7194
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 054013583 | IL | Yes |
Addresses
Primary practice location
25 E Washington St Lowr 53
Lower Level Pedway
Chicago, IL 60602-1736
Mailing address
25 E Washington St Lowr 53
Lower Level Pedway
Chicago, IL 60602-1736
Phone (312) 263-7194
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6060201 | Medicaid | IL | |
| 1449948 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names
- IVAN T MATTHEI PHARMACY
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.