Healthcare Provider Details

I. General information

NPI: 1346568540
Provider Name (Legal Business Name): J AND J PHARMACY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608, W. 69TH ST.
CHICAGO IL
60636-3316
US

IV. Provider business mailing address

1608, W. 69TH ST.
CHICAGO IL
60636-3316
US

V. Phone/Fax

Practice location:
  • Phone: 773-778-2356
  • Fax:
Mailing address:
  • Phone: 773-778-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051033681
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAGDISH P. DESAI
Title or Position: PRESIDENT/R.PH.
Credential: R.PH. CREGISTERED PH
Phone: 773-778-2356