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General NPI Number Information
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NPI Number | 1295891315
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Entity Type | Organization
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Legal Business Name | ENGLEWOOD RX PHARMACY, INC.
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Dates
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Enumeration Date | 01/01/2007
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Last Update Date | 03/10/2019
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Provider Practice Location Address
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Address Line | 6508 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60621-2616
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Country | US
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Telephone | 773-994-0247
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Fax | 773-994-1071
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Provider Business Mailing Address
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Address Line | 6508 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60621-2616
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Country | US
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Telephone | 773-994-0247
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Fax | 773-994-1071
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANISH VADIWALA
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Credential |
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Telephone | 773-994-0247
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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 | 054013612
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License Number State | IL
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