Healthcare Provider Details

I. General information

NPI: 1023031473
Provider Name (Legal Business Name): J &J PHARMACY LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 69TH STREET CLINIC PHARMACY
CHICAGO IL
60636
US

IV. Provider business mailing address

2001 W 69TH STREET
CHICAGO IL
60636
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 Code333600000X
TaxonomyPharmacy
License Number054014217
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051033681
License Number StateIL

VIII. Authorized Official

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