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General NPI Number Information
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NPI Number | 1598103194
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Entity Type | Organization
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Legal Business Name | PILSEN PHARMACY
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 06/05/2013
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Provider Practice Location Address
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Address Line | 1868 S BLUE ISLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60608-3013
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Country | US
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Telephone | 312-993-9500
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Fax | 312-993-9501
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Provider Business Mailing Address
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Address Line | 1868 S BLUE ISLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60608-3013
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Country | US
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Telephone | 312-993-9500
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Fax | 312-993-9501
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | DR. ROBERT ZAVALA
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Credential | PHARMD
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Telephone | 773-531-2058
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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 | 054018154
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License Number State | IL
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