Provider Demographics
NPI:1861906067
Name:PDI MEDICAL III LLC
Entity type:Organization
Organization Name:PDI MEDICAL III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:224-377-9734
Mailing Address - Street 1:1623 BARCLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4544
Mailing Address - Country:US
Mailing Address - Phone:224-436-1634
Mailing Address - Fax:
Practice Address - Street 1:1623 BARCLAY BOULEVARD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089
Practice Address - Country:US
Practice Address - Phone:224-436-1634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TINAD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-0322953336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy