=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326144460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORLAND HILLS PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2006
-----------------------------------------------------
Last Update Date | 10/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15300 WEST AVE SUITE 123
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-226-9840
-----------------------------------------------------
Fax | 708-226-9843
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15300 WEST AVE SUITE 123
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-226-9840
-----------------------------------------------------
Fax | 708-226-9843
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | PHILIP L GUASTELLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-226-9840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 54015253
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------