Provena Hospitals

NPI 1215025762

Information of Provena Hospitals

The NPI 1215025762 is an Organization type. NPI No 1215025762 belongs to Provena Hospitals. Provena Hospitals specializes in Community/Retail Pharmacy. is practising at 1315 N Highland Ave Ste 101, Aurora, Illinois 60506. You can also contact him via phone number (630) 801-5733.

Practice address located

  • 1315 N Highland Ave Ste 101
  • Aurora, Illinois 60506
  • (630) 801-5733
  • (630) 801-5733

Mailling address located

  • 1315 N Highland Ave Ste 101
  • Aurora, Illinois 60506
  • (630) 801-5733
  • (630) 801-5896
NPI No 1215025762
Primary Taxonomy
Authorized Official
Specialty of the provider
PrimaryTaxonomy CodeClassificationLicense NumberLicense State
Yes3336C0003XCommunity/Retail Pharmacy054-015054Illinois
Identifier for this provider
StateIdentifierTypeIssuer
n/a1219170007Medicare ID-Type Unspecifiedn/a
n/a1451424OtherNCPDP/NABP
IL=========034Medicaidn/a
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