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General NPI Number Information
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NPI Number | 1104217389
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Entity Type | Organization
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Legal Business Name | ADDISON PHARMACY, INC
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 4009 WARREN AVE STE 100
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City | BELLWOOD
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State | IL
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Zip | 60104-2066
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Country | US
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Telephone | 708-897-2424
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Fax | 708-897-2426
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Provider Business Mailing Address
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Address Line | 4009 WARREN AVE STE 100
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City | BELLWOOD
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State | IL
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Zip | 60104-2066
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Country | US
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Telephone | 708-897-2424
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Fax | 708-897-2426
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Authorized Official
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Title or Position | OWNER
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Name | KERUL MEHTA
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Credential | RPH.
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Telephone | 630-543-0988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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