Scholl Pharmacy Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

54014974 Issued in IL

Legal business name

SCHOLL PHARMACY INC

Doing business as

Fagen Pharmacy 17

Practice address

4840 W Court St
Monee, IL 60449-8988

Phone

(708) 534-3343

Fax

(708) 534-1638

NPI assigned

Jul 21, 2006

Last updated

May 21, 2008By 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

Connie Coffer

Title

3Rd Party Coord

Phone

(219) 987-6468

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• FAGEN PHARMACY 17 Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marjorie Laciak, PHARMD

  • Pharmacist
  • Valparaiso, IN
  • NPI 1699060988
  NPD

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1770504094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FAGEN PHARMACY",
            "address_2": "PO BOX 9830",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841099913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 W COURT ST",
            "city": "MONEE",
            "state": "IL",
            "postal_code": "604498988",
            "telephone_number": "708-534-3343",
            "fax_number": "708-534-1638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCHOLL PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "COFFER",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "3RD PARTY COORD",
        "authorized_official_telephone_number": "219-987-6468"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "54014974",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1475905",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAGEN PHARMACY 17",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.