Healthcare Provider Details

I. General information

NPI: 1184789844
Provider Name (Legal Business Name): ROLET PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2006
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6032 S. HALSTED ST.
CHICAGO IL
60621
US

IV. Provider business mailing address

6032 S. HALSTED ST.
CHICAGO IL
60621
US

V. Phone/Fax

Practice location:
  • Phone: 773-994-7762
  • Fax: 773-994-2912
Mailing address:
  • Phone: 773-994-7762
  • Fax: 773-994-2912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051034263
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-041000
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054-017812
License Number StateIL

VIII. Authorized Official

Name: MR. AFZAL SIDDIQUI
Title or Position: PHARMACIST
Credential: PHARMD, RPH
Phone: 773-994-7762