Healthcare Provider Details

I. General information

NPI: 1548275175
Provider Name (Legal Business Name): VAISHALI PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 W CERMAK RD
CHICAGO IL
60623-3307
US

IV. Provider business mailing address

1206 RAYMOND TURN
BOURBONNAIS IL
60914-4799
US

V. Phone/Fax

Practice location:
  • Phone: 773-521-7422
  • Fax: 773-521-6986
Mailing address:
  • Phone: 773-521-7422
  • Fax: 773-521-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054013957
License Number StateIL

VIII. Authorized Official

Name: VISHAL PATEL
Title or Position: PRESIDENT
Credential: RPH
Phone: 773-521-7422