Healthcare Provider Details

I. General information

NPI: 1831516970
Provider Name (Legal Business Name): MIDWEST PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 02/12/2015
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:
Mailing address:
  • Phone: 773-379-7773
  • Fax: 773-379-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. TILAK MARWAHA
Title or Position: SHAREHOLDER
Credential:
Phone: 773-275-3769