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General NPI Number Information
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NPI Number | 1134161664
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Entity Type | Organization
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Legal Business Name | CHATHAM PHARMACY INC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 8419 S COTTAGE GROVE AVE
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City | CHICAGO
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State | IL
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Zip | 60619-6113
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Country | US
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Telephone | 773-874-0425
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Fax | 773-874-0464
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Provider Business Mailing Address
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Address Line | 8419 S COTTAGE GROVE AVE
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City | CHICAGO
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State | IL
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Zip | 60619-6113
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Country | US
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Telephone | 773-874-0425
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Fax | 773-874-0464
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Authorized Official
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Title or Position | HEAD PHARMACIST
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Name | KAMLESH SHAH
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Credential | B S PHARMACY
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Telephone | 773-874-0425
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054.014149
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License Number State | IL
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