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General NPI Number Information
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NPI Number | 1023043643
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Entity Type | Organization
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Legal Business Name | JW PHARMACY & DME INC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 5101 WILLOW SPRINGS RD
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City | LA GRANGE
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State | IL
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Zip | 60525-2600
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Country | US
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Telephone | 708-588-0300
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Fax | 708-588-0302
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Provider Business Mailing Address
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Address Line | PO BOX 744
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City | LA GRANGE
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State | IL
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Zip | 60525-0744
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Country | US
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Telephone | 708-588-0300
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Fax | 708-588-0302
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | DR. WAFA DAKI
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Credential | PHARM.D.
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Telephone | 708-588-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 054015550
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License Number State | IL
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