Southgate Pharmacy Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

SOUTHGATE PHARMACY INC.

Practice address

18659 Dixie Hwy
Homewood, IL 60430-3728

Phone

(708) 798-2100

Fax

(708) 798-0686

NPI assigned

Oct 25, 2005

Organization subpart

No

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

Authorized official

Name

Leonard J Skoniecke Jr.

Title

Manager

Phone

(708) 798-2100

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578553152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18659 DIXIE HWY",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604303728",
            "telephone_number": "708-798-2100",
            "fax_number": "708-798-0686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18659 DIXIE HWY",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604303728",
            "telephone_number": "708-798-2100",
            "fax_number": "708-798-0686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHGATE PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SKONIECKE",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "708-798-2100",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "1401594",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in Homewood, IL
• Providers in Homewood, IL by specialty
• Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.