111TH Pharma-Family

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

051035317 Issued in IL

Legal business name

111TH PHARMA-FAMILY

Practice address

11101 S State St
Chicago, IL 60628-4206

Phone

(708) 503-9845

NPI assigned

Dec 10, 2012

Last updated

Dec 10, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Adele Vanjackson, RPH

Title

Owner/Pharmacist

Phone

(708) 503-9845

Specialties & licenses 1

Addresses

Tax ID family

111TH Pharma - Family2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• 111TH Pharma - Family

  • Community/Retail Pharmacy
  • Chicago, IL
  • NPI 1255415386
  NPD tax ID

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

{
    "created_epoch": "1355097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355097600000",
    "number": "1659616175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11101 S STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606284206",
            "telephone_number": "708-503-9845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11101 S STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606284206",
            "telephone_number": "708-503-9845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "111TH PHARMA-FAMILY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-10",
        "last_updated": "2012-12-10",
        "status": "A",
        "authorized_official_last_name": "VANJACKSON",
        "authorized_official_first_name": "ADELE",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "708-503-9845",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "IL",
            "license": "051035317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 1 On 1 MD PLLC
• 1 Stop Medical Supply Shop
• 1-On-1 MD, LLC
• 105 W Madison Dental PC
• 111TH Pharma - Family
• 1801075429 (Muthuswamy Petham P MD)
• 1863FWD Care 2 Care NFP (1863 Care 2 Care)
• 1915-25 95TH St., LLC
• 1918 Winter Street Operating Co LLC (Mariano's Pharmacy #0522)
• 1918 Winter Street Operating Co LLC (Mariano's Pharmacy #0538)

• Health Service Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Health Service Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2012; 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.