Healthcare Provider Details

I. General information

NPI: 1518031038
Provider Name (Legal Business Name): GABRIEL DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 W 16TH ST
CHICAGO IL
60623-1041
US

IV. Provider business mailing address

4304 W 16TH ST
CHICAGO IL
60623-1041
US

V. Phone/Fax

Practice location:
  • Phone: 773-277-2187
  • Fax: 773-277-2170
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: DIPAK SHAN
Title or Position: PRES
Credential: RPH
Phone: 723-277-2187