Provider Demographics
NPI:1316470123
Name:INTERDEPENDENT PHARMACY, LLC
Entity type:Organization
Organization Name:INTERDEPENDENT PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAKUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:224-392-2666
Mailing Address - Street 1:1778 SOMERSET LN
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-5363
Mailing Address - Country:US
Mailing Address - Phone:224-392-2666
Mailing Address - Fax:
Practice Address - Street 1:404 N SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1835
Practice Address - Country:US
Practice Address - Phone:224-475-0020
Practice Address - Fax:224-475-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy