Healthcare Provider Details

I. General information

NPI: 1972866135
Provider Name (Legal Business Name): WELL FUTURE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 N WELLS ST
CHICAGO IL
60654-3616
US

IV. Provider business mailing address

122 W 146TH ST
NEW YORK NY
10039-3802
US

V. Phone/Fax

Practice location:
  • Phone: 312-589-7620
  • Fax: 312-589-7621
Mailing address:
  • Phone: 888-685-9515
  • Fax: 646-934-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054017943
License Number StateIL

VIII. Authorized Official

Name: ERIC KINARIWALA
Title or Position: SOLE MEMBER
Credential:
Phone: 888-685-9515