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General NPI Number Information
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NPI Number | 1235405663
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Entity Type | Organization
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Legal Business Name | ELGIN WEST PHARMACY INC
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 1554 TODD FARM DR
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City | ELGIN
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State | IL
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Zip | 60123-1287
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Country | US
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Telephone | 847-627-4600
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Fax | 847-627-4652
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Provider Business Mailing Address
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Address Line | 1554 TODD FARM DR
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City | ELGIN
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State | IL
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Zip | 60123-1287
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Country | US
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Telephone | 847-627-4600
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Fax | 847-627-4652
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Authorized Official
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Title or Position | PHARMICIST IN CHARGE
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Name | ARVIND SURTI
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Credential | RPH
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Telephone | 847-627-4600
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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 | 054-017931
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License Number State | IL
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