Provider Demographics
NPI:1902801087
Name:CONSUMERS PHARMACY INC.
Entity Type:Organization
Organization Name:CONSUMERS PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEBDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:708-757-4030
Mailing Address - Street 1:1 SURREYBROOK PLAZA
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411
Mailing Address - Country:US
Mailing Address - Phone:708-757-4030
Mailing Address - Fax:708-757-4728
Practice Address - Street 1:1 SURREYBROOK PLAZA
Practice Address - Street 2:
Practice Address - City:SAUK VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60411
Practice Address - Country:US
Practice Address - Phone:708-757-4030
Practice Address - Fax:708-757-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0053008445333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1449239OtherNABP
IL=========001Medicaid
IL0146140001Medicare ID - Type Unspecified