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General NPI Number Information
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NPI Number | 1265447858
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Entity Type | Organization
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Legal Business Name | A & D FAMILY MEDICAL CENTER PHARMACY INC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 732 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60624-4058
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Country | US
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Telephone | 773-826-1719
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Fax | 773-533-1622
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Provider Business Mailing Address
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Address Line | 8352 N NEWLAND AVE
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City | NILES
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State | IL
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Zip | 60714-2642
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Country | US
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Telephone | 773-826-1719
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Fax | 773-533-1622
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Authorized Official
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Title or Position | PRESIDENT
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Name | KISHORKANT CHIKANI
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Credential |
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Telephone | 773-826-1719
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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 | 054008831
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License Number State | IL
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