Healthcare Provider Details

I. General information

NPI: 1801883608
Provider Name (Legal Business Name): TVS RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 W MADISON ST
CHICAGO IL
60644-4031
US

IV. Provider business mailing address

5470 W MADISON ST
CHICAGO IL
60644-4031
US

V. Phone/Fax

Practice location:
  • Phone: 773-379-7773
  • Fax: 773-379-1020
Mailing address:
  • Phone: 773-379-7773
  • Fax: 773-379-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number540014342
License Number StateIL

VIII. Authorized Official

Name: TILAK MARWAHA
Title or Position: PRESIDENT
Credential: MS RPH
Phone: 773-379-7773