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General NPI Number Information
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NPI Number | 1619285509
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Entity Type | Organization
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Legal Business Name | SIMPLE RX INC.
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 527 WEST MAIN ST. UNIT 1W UNIT 1W
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City | KIRKLAND
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State | IL
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Zip | 60146
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Country | US
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Telephone | 815-522-3898
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Fax | 815-522-3859
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Provider Business Mailing Address
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Address Line | PO BOX 4
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City | KIRKLAND
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State | IL
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Zip | 60146-0004
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Country | US
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Telephone | 815-522-3898
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Fax | 815-522-3859
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. RUPESH BHARAT MANEK
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Credential | RPH
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Telephone | 815-522-3898
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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 | 054017556
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License Number State | IL
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