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NPI Code Detail

MEDICARE: LAVIR PHARMACY INC

MEDICARE: LAVIR PHARMACY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0002XClinic Pharmacy
43336C0003XCommunity/Retail Pharmacy054016489IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12117316OTHERPK

General Provider Information

NPI Number : 1518116219
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAVIR PHARMACY INC
Provider Business Mailing Address
First Line : 4959 W BELMONT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-4332
Country : US
Telephone Number : 773-853-2374
Fax Number : 773-853-2365
Provider Business Practice Location Address
First Line : 4959 W BELMONT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-4332
Country : US
Telephone Number : 773-853-2374
Fax Number : 773-853-2365
Authorized Official
Title or Position : MANAGER RPH IN CHARGE
Name : KIRITKUMAR PATEL
Credential : RPH
Telephone Number : 773-853-2374
Provider Enumeration Date : 09/17/2008
Last Update Date : 12/22/2017

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Directions to “LAVIR PHARMACY INC ” Practice Location

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