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General NPI Number Information
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NPI Number | 1558163923
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Entity Type | Organization
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Legal Business Name | 108 PHARMA CORP
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 300 MADSEN DRIVE SUITE 101 ROOM 201
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City | BLOOMINGDALE
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State | IL
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Zip | 60108
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Country | US
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Telephone | 630-423-8511
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Fax | 630-423-8522
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Provider Business Mailing Address
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Address Line | 300 MADSEN DRIVE SUITE 101 ROOM 201
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City | BLOOMINGDALE
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State | IL
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Zip | 60108
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Country | US
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Telephone | 630-423-8511
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Fax | 630-423-8522
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Authorized Official
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Title or Position | CEO
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Name | DINESH RAJANI
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Credential |
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Telephone | 847-997-8451
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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