Healthcare Provider Details

I. General information

NPI: 1043231095
Provider Name (Legal Business Name): VALUE VILLAGE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 E SIBLEY BLVD
DOLTON IL
60419-2599
US

IV. Provider business mailing address

618 E SIBLEY BLVD
DOLTON IL
60419-2599
US

V. Phone/Fax

Practice location:
  • Phone: 708-849-3900
  • Fax: 708-849-1930
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number54011255
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: OM DHINGRA
Title or Position: PRESIDENT
Credential:
Phone: 708-849-3900