Healthcare Provider Details

I. General information

NPI: 1902417207
Provider Name (Legal Business Name): IPACK PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 W NORTH AVE STE 108W
BROOKFIELD WI
53005-4423
US

IV. Provider business mailing address

17000 W NORTH AVE STE 108W
BROOKFIELD WI
53005-4423
US

V. Phone/Fax

Practice location:
  • Phone: 262-649-3900
  • Fax: 262-649-3076
Mailing address:
  • Phone: 262-649-3900
  • Fax: 262-649-3076

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: SUNNY DINESHKUMAR PATEL
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 262-649-3900