Healthcare Provider Details

I. General information

NPI: 1710342498
Provider Name (Legal Business Name): MAAR ILLINOIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S CENTRAL AVE
CHICAGO IL
60644-5059
US

IV. Provider business mailing address

645 S CENTRAL AVE
CHICAGO IL
60644-5059
US

V. Phone/Fax

Practice location:
  • Phone: 773-854-2500
  • Fax: 773-854-2600
Mailing address:
  • Phone: 773-854-2500
  • Fax: 773-854-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number054-019820
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RONAK MANEK
Title or Position: OWNER/PHARMACIST-IN-CHARGE
Credential:
Phone: 630-747-7495